Baharak Isabel Moallem, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

39920 Issued in TX

Practice address

1941 East Rd
Houston, TX 77054-6010

Phone

(713) 486-2700

NPI assigned

Apr 25, 2018

Reactivated

Feb 13, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ut Physicians

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1033157821
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1346738234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 EAST RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770546010",
            "telephone_number": "713-486-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 EAST RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770546010",
            "telephone_number": "713-486-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOALLEM",
        "first_name": "BAHARAK",
        "middle_name": "ISABEL",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-25",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "deactivation_date": "2018-06-12",
        "reactivation_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "021081",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "39920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• MNS Surgical Associates, PA
• Mo Medical Consulting
• Albert Mo, MD
• Christina Moak, LPC
• Joe L Moake, M.D.
• Olivia Couret Moas, MA, CF-SLP
• Alexandra Moauro, DO, PHD
• Monica Moawde
• Ahmad Aidan Moayyed, DMD
• Ali Moballegh, PHARM D

• Clinical Psychologist in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.