Provider Demographics
NPI:1770744252
Name:MOORE, JOAN FAYE (LPC-S, BSW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:FAYE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC-S, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:TX
Mailing Address - Zip Code:76431-0531
Mailing Address - Country:US
Mailing Address - Phone:940-389-0860
Mailing Address - Fax:940-644-5741
Practice Address - Street 1:223 COUNTY ROAD 1749
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:TX
Practice Address - Zip Code:76431-3124
Practice Address - Country:US
Practice Address - Phone:940-389-0860
Practice Address - Fax:940-644-5741
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165307301Medicaid