Individual
KAREN MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
8402 CROSS PARK DR, AUSTIN, TX 78754-4595
(512) 697-8573
Mailing address
4701 STAGGERBRUSH RD APT 214, AUSTIN, TX 78749-1039
(512) 919-0126
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
8050
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8050
LCDC
TX
Enumeration date
12/03/2012
Last updated
12/03/2012
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