Provider Demographics
NPI:1770380255
Name:MOORE, IVANA (LPC)
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:MOORE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24200 VIA MAZZINI WAY STE 250
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3439
Mailing Address - Country:US
Mailing Address - Phone:832-906-8743
Mailing Address - Fax:
Practice Address - Street 1:24200 VIA MAZZINI WAY STE 250
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3439
Practice Address - Country:US
Practice Address - Phone:832-906-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX87652101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor