MEDICARE: MS. MORGAN LANE MOORE CSC, LPC-ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	90953	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1033835251	OTHER	TX	INVICTA SERVICES GROUP, LLC

General Provider Information

NPI Number	:	1134900681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MORGAN LANE MOORE CSC, LPC-ASSOCIATE

Provider Business Mailing Address
First Line	:	9964 LEGACY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4192
Country	:	US
Telephone Number	:	817-808-5363
Fax Number	:

Provider Business Practice Location Address
First Line	:	7550 FM 1187 W
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-5109
Country	:	US
Telephone Number	:	888-744-2779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	11/30/2023

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