Provider Demographics
NPI:1851714265
Name:MOORE, LENAE (LPC CART)
Entity Type:Individual
Prefix:MS
First Name:LENAE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 BARTON HILLS DR APT 107
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2770
Mailing Address - Country:US
Mailing Address - Phone:817-269-1706
Mailing Address - Fax:
Practice Address - Street 1:5750 RUFE SNOW DR STE 130
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6140
Practice Address - Country:US
Practice Address - Phone:817-269-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional