Provider Demographics
NPI:1689241051
Name:DR. JANNIS MOODY, PLLC
Entity Type:Organization
Organization Name:DR. JANNIS MOODY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNIS
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-691-9273
Mailing Address - Street 1:21114 TWILA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2452
Mailing Address - Country:US
Mailing Address - Phone:323-691-9273
Mailing Address - Fax:
Practice Address - Street 1:11250 WEST RD STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4439
Practice Address - Country:US
Practice Address - Phone:323-691-9273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty