Individual
SANDI MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
609 E WASHINGTON ST, IDABEL, OK 74745-3319
(580) 217-7962
Mailing address
187 BUTLER POOL RD, IDABEL, OK 74745-5793
(580) 612-2112
(866) 988-7664
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
3530
OK
1041C0700X
Clinical Social Worker
Primary
4145
OK
Other
Enumeration date
01/03/2008
Last updated
10/08/2025
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