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General NPI Number Information
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NPI Number | 1386080596
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Entity Type | Individual
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Provider Name | MR. JEFFREY DONALD MOE
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Gender | Male
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 100 W DEAN KEETON ST A5800
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City | AUSTIN
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State | TX
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Zip | 78712-1091
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Country | US
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Telephone | 512-739-2997
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 S IH 35 SUITE 300
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City | AUSTIN
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State | TX
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Zip | 78741-3800
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Country | US
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Telephone | 512-739-2997
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | TX
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Taxonomy #2
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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 | TX
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