Provider Demographics
NPI:1417125949
Name:MOORE, MICHELE DENISE (LCSW-S)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:DENISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SPRINGFIELD LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7129
Mailing Address - Country:US
Mailing Address - Phone:214-542-5875
Mailing Address - Fax:
Practice Address - Street 1:122 SPRINGFIELD LN
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7129
Practice Address - Country:US
Practice Address - Phone:214-542-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0969-2348C1041C0700X
TX286181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical