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General NPI Number Information
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NPI Number | 1467430207
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Entity Type | Individual
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Provider Name | MARLIN KEM MOORE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 510 E STONER AVE
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City | SHREVEPORT
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State | LA
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Zip | 71101-4243
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Country | US
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Telephone | 318-990-4647
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 42
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City | ABILENE
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State | TX
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Zip | 79604-0042
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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 |
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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 | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 4810
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 24810
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License Number State | TX
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