Provider Demographics
NPI:1134900681
Name:MOORE, MORGAN LANE (CSC, LPC-ASSOCIATE)
Entity type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:LANE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CSC, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9964 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4192
Mailing Address - Country:US
Mailing Address - Phone:817-808-5363
Mailing Address - Fax:
Practice Address - Street 1:7550 FM 1187 W
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-5109
Practice Address - Country:US
Practice Address - Phone:888-744-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457482401Medicaid
TX1033835251OtherINVICTA SERVICES GROUP, LLC