Provider Demographics
NPI:1053425199
Name:MOORE, CYNTHIA DIANA (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DIANA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4111 PALMER PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4263
Mailing Address - Country:US
Mailing Address - Phone:713-201-5985
Mailing Address - Fax:832-230-1512
Practice Address - Street 1:7011 SOUTHWEST FWY
Practice Address - Street 2:2616 SOUTH LOOP, WEST, SUITE 602 HOUSTON, TX 77054
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2007
Practice Address - Country:US
Practice Address - Phone:713-970-7000
Practice Address - Fax:713-970-7246
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00006443LCOtherBLUECROSS BLUESHIELD - TX