Provider Demographics
NPI:1508521006
Name:MOORE, DEANNE (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 NUNLEY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4629
Mailing Address - Country:US
Mailing Address - Phone:972-345-7998
Mailing Address - Fax:
Practice Address - Street 1:4925 GREENVILLE AVE STE 570
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4036
Practice Address - Country:US
Practice Address - Phone:972-345-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202402101YM0800X
TX72316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty