Provider Demographics
NPI:1245682251
Name:MOORE, MEGAN (LPC)
Entity type:Individual
Prefix:MS
First Name:MEGAN
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 1:2002 COMMERCE ST STE C
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5538
Mailing Address - Country:US
Mailing Address - Phone:361-570-1444
Mailing Address - Fax:361-570-1446
Practice Address - Street 1:2002 COMMERCE ST STE C
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5538
Practice Address - Country:US
Practice Address - Phone:361-570-1444
Practice Address - Fax:361-570-1446
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TX76114101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX384851701Medicaid