Individual
ANTWON DEMETRIUS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-5700
(405) 601-1716
Mailing address
811 N OAK ST, PONCA CITY, OK 74601-3216
(580) 491-0699
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
J082366771
OK
Other
Enumeration date
07/06/2012
Last updated
07/06/2012
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