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General NPI Number Information
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NPI Number | 1356048508
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Entity Type | Organization
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Legal Business Name | MOORE PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 2409 QUITMAN AVE UNIT B
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City | LUBBOCK
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State | TX
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Zip | 79407-1146
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Country | US
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Telephone | 806-370-0858
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 4000
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MOLLY MOORE
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Credential | PHD
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Telephone | 806-370-0858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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