Provider Demographics
NPI:1750741575
Name:MOORE, SABASTAN II (MED, LPC-INTERN)
Entity type:Individual
Prefix:MR
First Name:SABASTAN
Middle Name:
Last Name:MOORE
Suffix:II
Gender:M
Credentials:MED, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7403 SAXON HILL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3847
Mailing Address - Country:US
Mailing Address - Phone:832-777-7808
Mailing Address - Fax:
Practice Address - Street 1:7403 SAXON HILL LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3847
Practice Address - Country:US
Practice Address - Phone:832-777-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional