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General NPI Number Information
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NPI Number | 1225689433
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Entity Type | Individual
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Provider Name | JOHN ALLEN MOORE LPC
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Gender | Male
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Dates
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Enumeration Date | 09/28/2019
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Last Update Date | 09/28/2019
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Provider Practice Location Address
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Address Line | 6141 W AMARILLO BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1901
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Country | US
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Telephone | 806-515-7853
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Fax | 806-730-2429
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Provider Business Mailing Address
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Address Line | PO BOX 85
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City | BOYS RANCH
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State | TX
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Zip | 79010-0085
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Country | US
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Telephone | 806-515-7853
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Fax | 806-730-2429
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 73782
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License Number State | TX
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