Provider Demographics
NPI:1083360069
Name:INNERSPACE PLLC
Entity Type:Organization
Organization Name:INNERSPACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC
Authorized Official - Phone:713-205-8117
Mailing Address - Street 1:19 BRIAR HOLLOW LANE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-205-8117
Mailing Address - Fax:866-502-3265
Practice Address - Street 1:19 BRIAR HOLLOW LANE
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:877-466-3701
Practice Address - Fax:866-502-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty