Individual
MRS. CONNIE B MOULDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
3800 SANDSHELL DR, SUITE 185, FORT WORTH, TX 76137-2429
(817) 205-3788
(817) 741-5549
Mailing address
9728 DELMONICO DR, KELLER, TX 76244-9559
(817) 205-3788
(817) 741-5549
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
14850
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LP0043168
—
TX
Enumeration date
11/08/2006
Last updated
08/19/2009
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