Provider Demographics
NPI:1376633214
Name:MOORE, BONNIE MADELINE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:MADELINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:M
Other - Last Name:LINDSKOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1922 WAGON GAP TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1026
Mailing Address - Country:US
Mailing Address - Phone:281-444-9553
Mailing Address - Fax:281-444-9553
Practice Address - Street 1:1922 WAGON GAP TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1026
Practice Address - Country:US
Practice Address - Phone:281-444-9553
Practice Address - Fax:281-444-9553
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19539 233304103TC1900X, 103K00000X, 101YP2500X
TX19539 233304103TF0200X
TX19539101YP2500X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760323389OtherCIGNA HEALTHCARE
TX256874OtherOLD COMPSYCH
TX570718OtherVALUEOPTIONS MHS#
TX11664355OtherOLD AETNA BEHAVIORAL HEALTH
TX1477756278OtherPURPOSE PSYCHOLOGY NPI
TX403328OtherPURPOSE PSYCHOLOGY'S MHN #
TX85495LOtherBCBS
TXH07190LC01OtherOLD BCBS
TX2554015OtherCIGNA BEHAVIORAL HEALTH
TX365283OtherMHN PROVIDER ID
TXH00028QK01OtherPURPOSE PSYCHOLOGY BCBS
TXH07280LC01OtherOLD BCBS NUMBER
TXH085495LOtherBCBS FULL NUMBER
TX21299221648OtherBEECHSTREET
TX9443845OtherOLD PHCS MULTI-PLAN
TX760323389OtherCIGNA HEALTHCARE
TX263898229OtherPURPOSE PSYCHOLOGY'S TIN/EIN
TX2554015OtherCIGNA BEHAVIORAL HEALTH
TX263898229OtherPURPOSE PSYCHOLOGY'S TIN/EIN