Provider Demographics
NPI:1013685304
Name:MOORE, CHRISTIAN (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 N BUCKNER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5633
Mailing Address - Country:US
Mailing Address - Phone:214-302-9608
Mailing Address - Fax:214-660-1916
Practice Address - Street 1:3535 N BUCKNER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-5633
Practice Address - Country:US
Practice Address - Phone:214-302-9608
Practice Address - Fax:214-660-1916
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health