MEDICARE: NATHALY MORENO LMFT

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	106H00000X	Marriage & Family Therapist	203516	TX

General Provider Information

NPI Number	:	1619512233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALY MORENO LMFT

Provider Business Mailing Address
First Line	:	1502 SAWYER ST STE 213
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-4445
Country	:	US
Telephone Number	:	832-301-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 SAWYER ST STE 213
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-4445
Country	:	US
Telephone Number	:	832-301-8218
Fax Number	:

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	06/03/2026

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