Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 76114 | TX |
NPI | 1245682251 |
---|---|
Provider Name | Ms. Megan Moore |
First Address | Victoria, TX 77901-5538 |
Second Address | Victoria, TX 77901-5538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2016 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
384851701 | (05) | TX |