Individual
BLAINE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
601 S MAIN ST, MANSFIELD, TX 76063-3112
(817) 914-2267
Mailing address
PO BOX 2114, MANSFIELD, TX 76063-0020
(817) 914-2267
(817) 225-2144
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
50464
TX
Other
Enumeration date
02/01/2007
Last updated
10/03/2024
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