Provider Demographics
NPI:1215171236
Name:MOSES, BEVERLY IONE (LCDC)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:IONE
Last Name:MOSES
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10134 FINCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7604
Mailing Address - Country:US
Mailing Address - Phone:713-875-0274
Mailing Address - Fax:
Practice Address - Street 1:10134 FINCHWOOD LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7604
Practice Address - Country:US
Practice Address - Phone:713-875-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9443101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)