Samuel Evan Moore, M.S.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT119605 Issued in CA

Practice address

10776 Fremont St
Yucaipa, CA 92399-9630

Phone

(909) 797-0114

Fax

(909) 790-2148

NPI assigned

Jun 14, 2016

Sex

Male

Sole proprietor

No

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

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trinity Youth Services

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Yucaipa, CA
  • NPI 1861848525
  NPD (past)

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1447600085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10776 FREMONT ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923999630",
            "telephone_number": "909-797-0114",
            "fax_number": "909-790-2148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10776 FREMONT ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923999630",
            "telephone_number": "909-797-0114",
            "fax_number": "909-790-2148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SAMUEL",
        "middle_name": "EVAN",
        "credential": "M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-14",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF91033",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT119605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traci Colleen Mohler, LMFT
• Florin Gabriel Moldovan, PHARMD
• Gabriel Molina, NP
• Wendy Montgomery
• Taneice Monae Mooney
• Suzanne Charlotte Moore, NP
• Zulema Moore, LCSW
• Raymundo A Morales, M.D.
• Ashley Moreno
• Rebecca Moruzzi

• Marriage & Family Therapist in Yucaipa, CA
• Providers in Yucaipa, 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 4, 2021; 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.