Provider Demographics
NPI:1386788909
Name:MOORE, ALLISON (PHD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-592-8952
Mailing Address - Fax:
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:SUITE 600
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:713-592-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30845103TC0700X
TX31196103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7920194OtherAETNA
TX00951EMedicare ID - Type Unspecified