Individual
LINDA KAREN BURT MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D.
Contact information
Practice address
4949 FRANKLIN AVE, WACO, TX 76710-6900
(254) 776-0400
(254) 776-0637
Mailing address
4949 FRANKLIN AVE STE 310, WACO, TX 76710-6900
(254) 776-0400
(254) 776-0637
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
24997
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036135401
—
TX
01
—
119210
CHIP PROVIDER NUMBER
TX
01
—
119784100
SWL PROVIDER NUMBER
TX
Enumeration date
10/26/2005
Last updated
01/27/2021
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