MEDICARE: ELIZABETH MOORE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	14291	TX

General Provider Information

NPI Number	:	1609876457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MOORE LPC

Provider Business Mailing Address
First Line	:	901 WALLACE BLVD
Second Line	:	BLDG. 501
City	:	AMARILLO
State	:	TX
Zip	:	79106-1705
Country	:	US
Telephone Number	:	806-349-5646
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 WALLACE BLVD
Second Line	:	BLDG. 501
City	:	AMARILLO
State	:	TX
Zip	:	79106-1705
Country	:	US
Telephone Number	:	806-349-5646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/09/2007

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