Logan Moody

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

384134 Issued in CA

Practice address

361 3Rd St Ste B
San Rafael, CA 94901-3580

Phone

(415) 572-0813

NPI assigned

Aug 9, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1154004869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 3RD ST STE B",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013580",
            "telephone_number": "415-572-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 3RD ST STE B",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013580",
            "telephone_number": "415-572-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "LOGAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-09",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Drama Therapist",
            "state": "CA",
            "license": "31043",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "384134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Constanza Montejo-Kadera, DDS
• Justin Montello
• Sobeyda M Monterroso Ramirez, RD
• Marci Nicole Montes, O.T.R.L.
• Monica Marie Montury
• Nastassia Marie Moore-Walker
• Dion Ray Moore
• Donald Robert Moore
• Erin K Moore, CCAPP
• Gina Borelli Moore, MA, MFT

• Marriage & Family Therapist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.