Provider Demographics
NPI:1053418566
Name:MOORE, SYLVIA (MA LPC)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13438 BANDERA RD
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023
Mailing Address - Country:US
Mailing Address - Phone:210-695-1788
Mailing Address - Fax:210-695-6868
Practice Address - Street 1:13438 BANDERA RD
Practice Address - Street 2:SUITE 105B
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023
Practice Address - Country:US
Practice Address - Phone:210-695-1788
Practice Address - Fax:210-695-6868
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19086103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist