Healthcare Provider Details

I. General information

NPI: 1508298357
Provider Name (Legal Business Name): SHIRLEY MOXLEY MA, LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2013
Last Update Date: 08/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 CAVENDER DR
HURST TX
76053-4002
US

IV. Provider business mailing address

6017 MALVEY AVE
FORT WORTH TX
76116-4638
US

V. Phone/Fax

Practice location:
  • Phone: 972-342-6568
  • Fax:
Mailing address:
  • Phone: 972-342-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61925
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: