Individual
ELIZABETH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
414 N MAIN ST UNIT 103, GRAPEVINE, TX 76051-3395
(817) 385-6264
Mailing address
1400 DARTMOUTH DR, SOUTHLAKE, TX 76092-7103
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
205873
TX
Other
Enumeration date
01/11/2025
Last updated
01/11/2025
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