=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326921081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCUS ANDRE MORELAND LPC-ASSOCIATE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2025
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 N CENTRAL EXPY STE 310
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-231-3213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 WILLIAMS ST
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75104-5066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-337-2951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 92996
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------