Provider Demographics
NPI:1740456805
Name:MOORE, KEYVEN KARDELL (MA, MHC)
Entity type:Individual
Prefix:MR
First Name:KEYVEN
Middle Name:KARDELL
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 BRIARCLIFF CT N
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3205
Mailing Address - Country:US
Mailing Address - Phone:214-912-1375
Mailing Address - Fax:214-428-4074
Practice Address - Street 1:3520 BRIARCLIFF CT N
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3205
Practice Address - Country:US
Practice Address - Phone:214-912-1375
Practice Address - Fax:214-428-4074
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17033104100000X, 103K00000X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor