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General NPI Number Information
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NPI Number | 1366792194
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Entity Type | Individual
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Provider Name | RUNE LASSEN MOELBAK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 10/08/2016
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Provider Practice Location Address
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Address Line | 3400 BISSONNET ST STE 270
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City | HOUSTON
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State | TX
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Zip | 77005-2155
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Country | US
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Telephone | 832-542-6244
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Fax |
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Provider Business Mailing Address
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Address Line | 5925 ALMEDA RD UNIT 11509
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City | HOUSTON
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State | TX
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Zip | 77004-7673
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Country | US
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Telephone | 412-726-0382
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36117
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License Number State | TX
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