Individual
CHARLES CLIFTON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
11211 TAYLOR DRAPER LN, SUITE 202, AUSTIN, TX 78759-3916
(512) 343-8850
(512) 674-9050
Mailing address
11211 TAYLOR DRAPER LN, SUITE 202, AUSTIN, TX 78759-3916
(512) 343-8850
(512) 674-9050
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
25072
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079974401
—
TX
Enumeration date
07/12/2006
Last updated
08/21/2013
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