MEDICARE: LATRICE M MOORE

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

General Provider Information

NPI Number	:	1891293130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRICE M MOORE

Provider Business Mailing Address
First Line	:	6322 LEDBETTER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5047
Country	:	US
Telephone Number	:	225-385-4543
Fax Number	:	866-825-9703

Provider Business Practice Location Address
First Line	:	6322 LEDBETTER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5047
Country	:	US
Telephone Number	:	225-385-4543
Fax Number	:	866-825-9703

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

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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Directions to “ LATRICE M MOORE ” Practice Location

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