Provider Demographics
NPI:1396511283
Name:MOORE, SHALONDRA YULETTE (LPC)
Entity type:Individual
Prefix:
First Name:SHALONDRA
Middle Name:YULETTE
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 1:20435 KITTREDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-1551
Mailing Address - Country:US
Mailing Address - Phone:713-582-8236
Mailing Address - Fax:
Practice Address - Street 1:15355 VANTAGE PKWY W STE 235
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-1975
Practice Address - Country:US
Practice Address - Phone:281-891-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health