Individual
ALEC MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
908 S LEE ST STE A, FORT GIBSON, OK 74434-8735
(918) 203-3789
(918) 203-3116
Mailing address
908 S LEE ST STE A, FORT GIBSON, OK 74434-8735
(918) 203-3789
(918) 203-3116
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200540800B
—
OK
Enumeration date
01/09/2014
Last updated
08/27/2019
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