Provider Demographics
NPI:1891293130
Name:MOORE, LATRICE M
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 LEDBETTER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-5047
Mailing Address - Country:US
Mailing Address - Phone:225-385-4543
Mailing Address - Fax:866-825-9703
Practice Address - Street 1:6322 LEDBETTER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-5047
Practice Address - Country:US
Practice Address - Phone:225-385-4543
Practice Address - Fax:866-825-9703
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health