MEDICARE: MOORE RESILIENCY BEHAVIORAL HEALTH

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1659253888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE RESILIENCY BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	6107 SHELBOURNE PARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1895
Country	:	US
Telephone Number	:	713-702-9109
Fax Number	:

Provider Business Practice Location Address
First Line	:	6107 SHELBOURNE PARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1895
Country	:	US
Telephone Number	:	713-702-9109
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACINA Y MOORE
Credential	:
Telephone Number	:	713-702-9109

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	02/03/2026

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