Provider Demographics
NPI:1659826766
Name:MOORE, NICOLE E (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:ECHEVERRIA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:12307 ELK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2297
Mailing Address - Country:US
Mailing Address - Phone:713-213-4097
Mailing Address - Fax:
Practice Address - Street 1:12307 ELK MEADOW DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2297
Practice Address - Country:US
Practice Address - Phone:713-213-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional