Provider Demographics
NPI:1750319604
Name:MOORE, TERRY W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2606
Mailing Address - Country:US
Mailing Address - Phone:713-824-9444
Mailing Address - Fax:
Practice Address - Street 1:6100 RICHMOND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6228
Practice Address - Country:US
Practice Address - Phone:832-242-7500
Practice Address - Fax:832-242-7800
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS31242101YA0400X, 101YM0800X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00647PMedicare PIN