Provider Demographics
NPI:1326825613
Name:MOODY, MARIE M (LPC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:MOODY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 SCARLET RDG
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-9319
Mailing Address - Country:US
Mailing Address - Phone:512-689-4330
Mailing Address - Fax:
Practice Address - Street 1:28465 RANCH ROAD 12
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3795
Practice Address - Country:US
Practice Address - Phone:512-689-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health