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General NPI Number Information
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NPI Number | 1376031666
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Entity Type | Individual
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Provider Name | TRAVIS MOORE LPC
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Gender | Male
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 1350 N BUCKNER BLVD STE 220
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City | DALLAS
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State | TX
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Zip | 75218-3566
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Country | US
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Telephone | 972-602-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 1419 MONTEGO CT
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City | ROCKWALL
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State | TX
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Zip | 75087-7209
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Country | US
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Telephone | 214-677-6307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 74796
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License Number State | TX
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