MEDICARE: ERIKA MOORE

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	72268	TX

General Provider Information

NPI Number	:	1922939842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA MOORE

Provider Business Mailing Address
First Line	:	28120 BASS KNL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-4433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W MAIN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1929
Country	:	US
Telephone Number	:	917-525-1544
Fax Number	:

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ ERIKA MOORE ” Practice Location

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