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General NPI Number Information
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NPI Number | 1083360069
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Entity Type | Organization
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Legal Business Name | INNERSPACE PLLC
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 19 BRIAR HOLLOW LANE SUITE 120
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City | HOUSTON
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State | TX
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Zip | 77027
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Country | US
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Telephone | 877-466-3701
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Fax | 866-502-3265
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Provider Business Mailing Address
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Address Line | 19 BRIAR HOLLOW LANE SUITE 120
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City | HOUSTON
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State | TX
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Zip | 77027
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Country | US
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Telephone | 713-205-8117
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Fax | 866-502-3265
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | ANDREA MOORER
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Credential | LCSW, LCDC
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Telephone | 713-205-8117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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