Provider Demographics
NPI:1083818256
Name:MOORE, STEVEN A (LPC-S, NCC, MAC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:A
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPC-S, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 DACOMA ST
Mailing Address - Street 2:C/O MHMRA NORTHWEST COMMUNITY SERVICE CENTER
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8905
Mailing Address - Country:US
Mailing Address - Phone:713-970-8577
Mailing Address - Fax:713-970-8421
Practice Address - Street 1:3737 DACOMA ST
Practice Address - Street 2:C/O MHMRA NORTHWEST COMMUNITY SERVICE CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8905
Practice Address - Country:US
Practice Address - Phone:713-970-8577
Practice Address - Fax:713-970-8421
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63996101YP2500X, 101YM0800X, 101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100249753-00Medicaid