Individual provider Active NPI

Amber Dawn Moreland, PH.D.

  • Psychologist
  • San Antonio, TX
National Provider Identifier
1740955020
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
3551 Roger Brooke Dr
San Antonio, TX 78234-4504
Phone
(210) 916-7500
NPI assigned
Aug 10, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary

Addresses

Primary practice location

3551 Roger Brooke Dr
San Antonio, TX 78234-4504

Mailing address

204 2ND St SW
PO Box 15
Puyallup, WA 98371
Phone (719) 439-0756

Other practice location 1

4014 23rd St SE
Puyallup, WA 98374-4553
Phone (719) 439-0756

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jul 22, 2024 through Jul 22, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1740955020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 2ND ST SW",
            "address_2": "PO BOX 15",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "98371",
            "telephone_number": "719-439-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4014 23rd St SE",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983744553",
            "country_code": "US",
            "telephone_number": "719-439-0756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORELAND",
        "first_name": "AMBER",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-10",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.