Provider Demographics
NPI:1376791970
Name:MOYERS-HOUSER, KELLIE RENE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:RENE
Last Name:MOYERS-HOUSER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:KELLIE
Other - Middle Name:RENE
Other - Last Name:MOYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1103 KELLER PKWY
Mailing Address - Street 2:STE 107
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3600
Mailing Address - Country:US
Mailing Address - Phone:817-343-9230
Mailing Address - Fax:817-514-8701
Practice Address - Street 1:1103 KELLER PKWY
Practice Address - Street 2:STE 107
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3600
Practice Address - Country:US
Practice Address - Phone:817-343-9230
Practice Address - Fax:817-514-8701
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18591101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist