Individual
SHAWNA DONISE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LPC, BCBA
Contact information
Practice address
614 S MAIN ST, STILLWATER, OK 74074-4059
(405) 824-3408
(405) 564-0062
Mailing address
2118 N MANNING ST, STILLWATER, OK 74075-2950
(405) 824-3408
(405) 564-0062
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4885
OK
103K00000X
Behavior Analyst
1-15017996
OK
Other
Enumeration date
04/12/2011
Last updated
02/26/2020
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