Individual ProviderNicole Susan MooreMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address2716 Wilshire Blvd, Santa Monica, CA 90403-4706(310) 957-9191PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Susan Moore does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1235795618Provider TypeIndividualFull NameMoore, Nicole SusanCredentialMFTGenderFemaleSole ProprietorYesEnumeration Date5/11/2019Last Updated5/11/2019Contact InformationPractice LocationPractice Address2716 Wilshire Blvd, Santa Monica, CA 90403-4706Phone(310) 957-9191FaxUnlisted FaxMailing LocationMailing Address2716 Wilshire Blvd, Santa Monica, CA 90403-4706Phone(310) 957-9191FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense105134California