Individual
BROOKE NICOLE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
367 W CHICKEN FIGHT RD, ATOKA, OK 74525-4110
(580) 513-0573
Mailing address
PO BOX 562, ATOKA, OK 74525-0562
(580) 513-0573
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
OK
103K00000X
Behavior Analyst
Primary
—
OK
Other
Enumeration date
04/24/2015
Last updated
04/24/2015
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