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General NPI Number Information
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NPI Number | 1457652273
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Entity Type | Individual
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Provider Name | VICKI LYNNETTE MOODY MA, LPC-S, LCDC, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 1701 GATEWAY BLVD SUITE 405
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City | RICHARDSON
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State | TX
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Zip | 75080-3572
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Country | US
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Telephone | 214-532-6527
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Fax | 972-644-5512
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Provider Business Mailing Address
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Address Line | 1701 GATEWAY BLVD SUITE 405
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City | RICHARDSON
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State | TX
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Zip | 75080-3572
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Country | US
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Telephone | 214-532-6527
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Fax | 972-644-5512
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 65206
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License Number State | TX
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