Provider Demographics
NPI:1609234434
Name:MOORE COUNSELING AND WELLNESS, INC.
Entity Type:Organization
Organization Name:MOORE COUNSELING AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:817-914-2267
Mailing Address - Street 1:PO BOX 2114
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0020
Mailing Address - Country:US
Mailing Address - Phone:817-914-2267
Mailing Address - Fax:817-225-2144
Practice Address - Street 1:1751 BROAD PARK CIR S STE 207
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7827
Practice Address - Country:US
Practice Address - Phone:817-914-2267
Practice Address - Fax:817-225-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty