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NPI Code Detail

MEDICARE: MRS. MOLLY MOORE LPC

MEDICARE: MRS. MOLLY MOORE LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1275003410
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MOLLY MOORE LPC
Provider Business Mailing Address
First Line : 7925 S BROADWAY AVE STE 820
Second Line :
City : TYLER
State : TX
Zip : 75703-5255
Country : US
Telephone Number : 903-561-8955
Fax Number : 903-561-8895
Provider Business Practice Location Address
First Line : 7925 S BROADWAY AVE STE 820
Second Line :
City : TYLER
State : TX
Zip : 75703-5255
Country : US
Telephone Number : 903-561-8955
Fax Number : 903-561-8895
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2018
Last Update Date : 11/30/2018

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Directions to “ MRS. MOLLY MOORE LPC” Practice Location

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