Provider Demographics
NPI:1124582689
Name:MOORE, KAREN VERNELL (LBSW, LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:VERNELL
Last Name:MOORE
Suffix:
Gender:F
Credentials:LBSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 MORNING GLORY CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4507
Mailing Address - Country:US
Mailing Address - Phone:832-594-0799
Mailing Address - Fax:
Practice Address - Street 1:4611 MORNING GLORY CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4507
Practice Address - Country:US
Practice Address - Phone:832-594-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional