MEDICARE: JESSIE MOORE LPC

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	101YP2500X	Professional Counselor	86971	TX

General Provider Information

NPI Number	:	1245084920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE MOORE LPC

Provider Business Mailing Address
First Line	:	8111 LBJ FWY STE 900
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1322
Country	:	US
Telephone Number	:	214-336-9407
Fax Number	:

Provider Business Practice Location Address
First Line	:	8150 N CENTRAL EXPY STE 1625
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1806
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:

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

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	06/08/2026

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Directions to “ JESSIE MOORE LPC” Practice Location

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