Provider Demographics
NPI:1982776969
Name:MOORE, LYNDA LEE (LPCC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 EL CENTRO FAMILIAR BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4502
Mailing Address - Country:US
Mailing Address - Phone:505-873-1604
Mailing Address - Fax:505-877-3533
Practice Address - Street 1:1710 EL CENTRO FAMILIAR BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4502
Practice Address - Country:US
Practice Address - Phone:505-873-1604
Practice Address - Fax:505-877-3533
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health