Provider Demographics
NPI:1427705110
Name:MOORHEAD, MARY (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MOORHEAD
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 BONNIE BRAE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5218
Mailing Address - Country:US
Mailing Address - Phone:713-582-6907
Mailing Address - Fax:
Practice Address - Street 1:2060 NORTH LOOP W STE 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8146
Practice Address - Country:US
Practice Address - Phone:713-839-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18366101YP2500X
TX5103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional