Provider Demographics
NPI:1659253888
Name:MOORE RESILIENCY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:MOORE RESILIENCY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-702-9109
Mailing Address - Street 1:6107 SHELBOURNE PARK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1895
Mailing Address - Country:US
Mailing Address - Phone:713-702-9109
Mailing Address - Fax:
Practice Address - Street 1:6107 SHELBOURNE PARK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1895
Practice Address - Country:US
Practice Address - Phone:713-702-9109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD18874966Medicaid