MEDICARE: AMANDA MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	88871	TX

General Provider Information

NPI Number	:	1386341204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MOORE

Provider Business Mailing Address
First Line	:	1401 LAKE PLAZA DR STE 200-215
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-1868
Country	:	US
Telephone Number	:	832-789-3447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 LAKE PLAZA DR STE 200-215
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-1868
Country	:	US
Telephone Number	:	832-789-3447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	04/02/2026

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Directions to “ AMANDA MOORE ” Practice Location

Language	Start Address	Practice Location

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