Provider Demographics
NPI:1063774446
Name:MOORE, KARLEN BROOK (PHD)
Entity type:Individual
Prefix:DR
First Name:KARLEN
Middle Name:BROOK
Last Name:MOORE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-0811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 S AUSTIN AVE # 1220
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5637
Practice Address - Country:US
Practice Address - Phone:512-959-8864
Practice Address - Fax:800-561-2019
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20216103T00000X
TX36119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
20216OtherPSYPACT APIT