Provider Demographics
NPI:1598596306
Name:MOORE-RUIZ, ALLISON PAIGE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:PAIGE
Last Name:MOORE-RUIZ
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 1:118 BUMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7569
Mailing Address - Country:US
Mailing Address - Phone:409-790-3050
Mailing Address - Fax:
Practice Address - Street 1:118 BUMSTEAD RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7569
Practice Address - Country:US
Practice Address - Phone:409-790-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90548101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health