1477989630 NPI number — MRS. KATHRYN MCCARTER MOORE LMSW

Table of content: MRS. KATHRYN MCCARTER MOORE LMSW (NPI 1477989630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477989630 NPI number — MRS. KATHRYN MCCARTER MOORE LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
KATHRYN
Provider Middle Name:
MCCARTER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCARTER
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477989630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 ROBINHOOD ST
Provider Second Line Business Mailing Address:
#1007
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77005-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-217-1985
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 ROBINHOOD ST
Provider Second Line Business Practice Location Address:
#1007
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77005-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-217-1985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2013

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: 104100000X , with the licence number:  57415 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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