Provider Demographics
NPI:1841704624
Name:MOORE, ULYSSES LEE (LPC)
Entity type:Individual
Prefix:
First Name:ULYSSES
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WATER SPANIEL WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3418
Mailing Address - Country:US
Mailing Address - Phone:512-589-9021
Mailing Address - Fax:
Practice Address - Street 1:1104 S MAYS ST STE 112
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6700
Practice Address - Country:US
Practice Address - Phone:151-258-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health