Provider Demographics
NPI:1114545456
Name:MOORE, CAITLYN MARIE
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 TURTLE BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:BOOTH
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2993
Mailing Address - Country:US
Mailing Address - Phone:512-783-5301
Mailing Address - Fax:
Practice Address - Street 1:1548 MINONITE RD STE 820
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-1281
Practice Address - Country:US
Practice Address - Phone:345-533-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-24-77957103K00000X
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician