Healthcare Provider Details

I. General information

NPI: 1770744252
Provider Name (Legal Business Name): JOAN FAYE MOORE L.P.C.-S, B.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 COUNTY ROAD 1749
CHICO TX
76431-3124
US

IV. Provider business mailing address

PO BOX 531
CHICO TX
76431-0531
US

V. Phone/Fax

Practice location:
  • Phone: 940-389-0860
  • Fax: 940-644-5741
Mailing address:
  • Phone: 940-389-0860
  • Fax: 940-644-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17306
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: