Provider Demographics
NPI:1013618198
Name:MOORE, ALICIA T (LMSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:T
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JONATHAN DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-6358
Mailing Address - Country:US
Mailing Address - Phone:512-277-0676
Mailing Address - Fax:737-250-7650
Practice Address - Street 1:101 JONATHAN DR UNIT 3
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6358
Practice Address - Country:US
Practice Address - Phone:512-277-0676
Practice Address - Fax:737-250-7650
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109881101YM0800X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker