Provider Demographics
NPI:1619273661
Name:MORAN, ANDREW LEONARD
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LEONARD
Last Name:MORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANDRES
Other - Middle Name:LEONARDO
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:608 VERNET ST
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4232
Mailing Address - Country:US
Mailing Address - Phone:469-556-4902
Mailing Address - Fax:
Practice Address - Street 1:9202 ELAM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4151
Practice Address - Country:US
Practice Address - Phone:214-266-1650
Practice Address - Fax:214-266-1824
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional