Provider Demographics
NPI:1558745042
Name:MOORE, CANDICE GAIL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:GAIL
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 GRANT RD
Mailing Address - Street 2:SUITE 115B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4400
Mailing Address - Country:US
Mailing Address - Phone:713-824-3950
Mailing Address - Fax:
Practice Address - Street 1:10601 GRANT RD
Practice Address - Street 2:SUITE 115B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4400
Practice Address - Country:US
Practice Address - Phone:713-824-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71711101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health