Provider Demographics
NPI:1326762196
Name:MOORE, LATYNIA RANAE (LCSW)
Entity Type:Individual
Prefix:
First Name:LATYNIA
Middle Name:RANAE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9659 N SAM HOUSTON PKWY
Mailing Address - Street 2:STE 150 BOX 116
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-3319
Mailing Address - Country:US
Mailing Address - Phone:281-979-6671
Mailing Address - Fax:
Practice Address - Street 1:9659 N SAM HOUSTON PKWY
Practice Address - Street 2:STE 150 116
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-3319
Practice Address - Country:US
Practice Address - Phone:281-979-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical