Individual
DR. KENNETH JERALD MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD LCSW
Contact information
Practice address
6906 S UTICA PL, TULSA, OK 74136-5158
(918) 794-4596
Mailing address
6906 S UTICA PL, TULSA, OK 74136-5158
(918) 794-4596
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2165
OK
Other
Enumeration date
10/26/2007
Last updated
08/14/2009
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