1376633214 NPI number — BONNIE MADELINE MOORE MA, LPC

Table of content: BONNIE MADELINE MOORE MA, LPC (NPI 1376633214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376633214 NPI number — BONNIE MADELINE MOORE MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
BONNIE
Provider Middle Name:
MADELINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINDSKOG
Provider Other First Name:
BONNIE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376633214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1922 WAGON GAP TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77090-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-444-9553
Provider Business Mailing Address Fax Number:
281-444-9553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1922 WAGON GAP TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77090-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-444-9553
Provider Business Practice Location Address Fax Number:
281-444-9553
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  19539 233304 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0200X , with the licence number: 19539 233304 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 19539 233304 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 19539 233304 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 19539 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 102L00000X , with the licence number: 19539 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 760323389 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 256874 . This is a "OLD COMPSYCH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 570718 . This is a "VALUEOPTIONS MHS#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 11664355 . This is a "OLD AETNA BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1477756278 . This is a "PURPOSE PSYCHOLOGY NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 403328 . This is a "PURPOSE PSYCHOLOGY'S MHN #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 85495L . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H07190LC01 . This is a "OLD BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2554015 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 365283 . This is a "MHN PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H00028QK01 . This is a "PURPOSE PSYCHOLOGY BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H07280LC01 . This is a "OLD BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H085495L . This is a "BCBS FULL NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 21299221648 . This is a "BEECHSTREET" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 9443845 . This is a "OLD PHCS MULTI-PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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