Provider Demographics
NPI:1790224012
Name:MOSES, LEE PAUL (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:PAUL
Last Name:MOSES
Suffix:
Gender:M
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 1:3909 WILLOW WAY RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6802
Mailing Address - Country:US
Mailing Address - Phone:817-346-0184
Mailing Address - Fax:
Practice Address - Street 1:3909 WILLOW WAY RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6802
Practice Address - Country:US
Practice Address - Phone:817-346-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health