Provider Demographics
NPI:1134905144
Name:MOORE, LATORSIA S
Entity type:Individual
Prefix:
First Name:LATORSIA
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATORSIA
Other - Middle Name:S
Other - Last Name:IVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25925 BUDDE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2011
Mailing Address - Country:US
Mailing Address - Phone:281-465-4468
Mailing Address - Fax:
Practice Address - Street 1:307 SAWDUST RD STE F
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2286
Practice Address - Country:US
Practice Address - Phone:346-351-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician