Provider Demographics
NPI:1427299981
Name:MOYER, MICHAEL (PHD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 KITTY HAWK RD
Mailing Address - Street 2:BLDG 2 - SUITE 226
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148
Mailing Address - Country:US
Mailing Address - Phone:210-412-4781
Mailing Address - Fax:210-598-1910
Practice Address - Street 1:433 KITTY HAWK RD
Practice Address - Street 2:BLDG 2 - SUITE 226
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148
Practice Address - Country:US
Practice Address - Phone:210-412-4781
Practice Address - Fax:210-598-1910
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional