Provider Demographics
NPI:1356631386
Name:MOORE, KRISTIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 RIVERBROOK DR STE 900A
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6531
Mailing Address - Country:US
Mailing Address - Phone:281-656-6624
Mailing Address - Fax:281-656-6621
Practice Address - Street 1:7002 RIVERBROOK DR STE 900A
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6531
Practice Address - Country:US
Practice Address - Phone:281-656-6624
Practice Address - Fax:281-656-6621
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34162103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist