Provider Demographics
NPI:1902605744
Name:MOEN-MALONE, AMBER DANIELLE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DANIELLE
Last Name:MOEN-MALONE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5873 TRIGG DR
Mailing Address - Street 2:
Mailing Address - City:WESTWORTH VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4141
Mailing Address - Country:US
Mailing Address - Phone:817-797-2434
Mailing Address - Fax:
Practice Address - Street 1:5873 TRIGG DR
Practice Address - Street 2:
Practice Address - City:WESTWORTH VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76114-4141
Practice Address - Country:US
Practice Address - Phone:817-797-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-124915106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician