Individual
JASON SHANE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
3110 H G MOSLEY PKWY STE 104, LONGVIEW, TX 75605-2941
(903) 758-2471
(903) 234-1639
Mailing address
107 WOODBINE PL, LONGVIEW, TX 75601-2912
(903) 758-2471
(903) 234-1639
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17751
TX
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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