MEDICARE: PURPOSE PSYCHOLOGY

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H00028QK01	OTHER	TX	BILLING PFIN, NETWORK: PAR

General Provider Information

NPI Number	:	1477756278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPOSE PSYCHOLOGY

Provider Business Mailing Address
First Line	:	1922 WAGON GAP TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1026
Country	:	US
Telephone Number	:	281-444-9553
Fax Number	:	281-444-9553

Provider Business Practice Location Address
First Line	:	1922 WAGON GAP TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1026
Country	:	US
Telephone Number	:	281-444-9553
Fax Number	:	281-444-9553

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BONNIE MADELINE MOORE
Credential	:	MA, LPC
Telephone Number	:	281-444-9553

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	01/30/2011

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Directions to “PURPOSE PSYCHOLOGY ” Practice Location

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