MEDICARE: ULYSSES LEE 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
1	101YM0800X	Mental Health Counselor	72885	TX

General Provider Information

NPI Number	:	1841704624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ULYSSES LEE MOORE LPC

Provider Business Mailing Address
First Line	:	1510 WATER SPANIEL WAY
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-3418
Country	:	US
Telephone Number	:	512-589-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 S MAYS ST STE 112
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6700
Country	:	US
Telephone Number	:	151-258-9902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	11/15/2021

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