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General NPI Number Information
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NPI Number | 1376633214
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Entity Type | Individual
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Provider Name | BONNIE MADELINE MOORE MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 01/30/2011
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Provider Practice Location Address
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Address Line | 1922 WAGON GAP TRL
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City | HOUSTON
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State | TX
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Zip | 77090-1026
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Country | US
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Telephone | 281-444-9553
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Fax | 281-444-9553
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Provider Business Mailing Address
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Address Line | 1922 WAGON GAP TRL
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City | HOUSTON
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State | TX
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Zip | 77090-1026
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Country | US
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Telephone | 281-444-9553
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Fax | 281-444-9553
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 19539 233304
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 19539 233304
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 19539 233304
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19539 233304
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19539
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 19539
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License Number State | TX
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