Healthcare Provider Details

I. General information

NPI: 1992412530
Provider Name (Legal Business Name): CHRISTOPHER MOORE LPC-ASSOCIATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SOUTHTOWN DR STE 106
GRANBURY TX
76048-2667
US

IV. Provider business mailing address

PO BOX 121835
ARLINGTON TX
76012-7835
US

V. Phone/Fax

Practice location:
  • Phone: 855-579-5323
  • Fax: 855-579-5323
Mailing address:
  • Phone: 855-579-5323
  • Fax: 855-579-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number81522
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number89400
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: