Provider Demographics
NPI:1396261913
Name:MOORE, BRYN ELIZABETH SCHIELE (PHD)
Entity type:Individual
Prefix:DR
First Name:BRYN
Middle Name:ELIZABETH SCHIELE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRYN
Other - Middle Name:ELIZABETH
Other - Last Name:SCHIELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3660 STONERIDGE RD.
Mailing Address - Street 2:F-101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-329-8222
Mailing Address - Fax:
Practice Address - Street 1:3660 STONERIDGE RD.
Practice Address - Street 2:F-101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-329-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37361103TC2200X
TX37631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent