Provider Demographics
NPI:1457652273
Name:MOODY, VICKI LYNNETTE (MA, LPC-S, LCDC, NCC)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNNETTE
Last Name:MOODY
Suffix:
Gender:F
Credentials:MA, LPC-S, LCDC, NCC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1701 GATEWAY BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3572
Mailing Address - Country:US
Mailing Address - Phone:214-532-6527
Mailing Address - Fax:972-644-5512
Practice Address - Street 1:1701 GATEWAY BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3572
Practice Address - Country:US
Practice Address - Phone:214-532-6527
Practice Address - Fax:972-644-5512
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65206101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor