Provider Demographics
NPI:1194362194
Name:MOORE, JUSTINE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 NASA RD. 1
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-4216
Mailing Address - Country:US
Mailing Address - Phone:281-262-2230
Mailing Address - Fax:
Practice Address - Street 1:1350 NASA ROAD 1
Practice Address - Street 2:SUITE 112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-4216
Practice Address - Country:US
Practice Address - Phone:281-262-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX585541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical