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General NPI Number Information
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NPI Number | 1538721808
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Entity Type | Individual
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Provider Name | JENTRELLE MOORE
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 10935 ESTATE LN
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City | DALLAS
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State | TX
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Zip | 75238-2316
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Country | US
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Telephone | 972-652-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 318 BUHLER DR
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City | GARLAND
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State | TX
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Zip | 75040-7807
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Country | US
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Telephone | 214-649-2141
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 81507
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 81507
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License Number State | TX
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