Provider Demographics
NPI:1841831534
Name:MOORE, TERRY LYNN (MS, LPC, LCCA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MS, LPC, LCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5467 ROGERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-2415
Mailing Address - Country:US
Mailing Address - Phone:254-829-1893
Mailing Address - Fax:254-829-1469
Practice Address - Street 1:5467 ROGERS HILL RD
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-2415
Practice Address - Country:US
Practice Address - Phone:254-829-1893
Practice Address - Fax:254-829-1469
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional