MEDICARE: JENNIFER 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	106H00000X	Marriage & Family Therapist	203540	TX

General Provider Information

NPI Number	:	1952050825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MOORE

Provider Business Mailing Address
First Line	:	8107 MANDERVILLE LN APT 1119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8107 MANDERVILLE LN APT 1119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3869
Country	:	US
Telephone Number	:	469-245-9369
Fax Number	:

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

Provider Enumeration Date	:	03/19/2022
Last Update Date	:	04/01/2022

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Directions to “ JENNIFER MOORE ” Practice Location

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