Provider Demographics
NPI:1508298357
Name:MOXLEY, SHIRLEY (MA, LPC-S)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MOXLEY
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 MALVEY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-4638
Mailing Address - Country:US
Mailing Address - Phone:972-342-6568
Mailing Address - Fax:
Practice Address - Street 1:1336 CAVENDER DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4002
Practice Address - Country:US
Practice Address - Phone:972-342-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional