MEDICARE: CHRISTINA JEANETTE MOOR LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	14450	TX

General Provider Information

NPI Number	:	1689140360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA JEANETTE MOOR LCDC

Provider Business Mailing Address
First Line	:	4518 TUSCARORA ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3521
Country	:	US
Telephone Number	:	832-584-7888
Fax Number	:

Provider Business Practice Location Address
First Line	:	7510 FM 1765
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-3672
Country	:	US
Telephone Number	:	409-944-4369
Fax Number	:

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

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	10/19/2018

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