Individual
HEATHER RENEE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
550 S PEORIA AVE, TULSA, OK 74120-3820
(918) 588-1900
(918) 382-1285
Mailing address
550 S PEORIA AVE, TULSA, OK 74120-3820
(918) 588-1900
(918) 382-1285
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5751
OK
101YP2500X
Professional Counselor
Primary
5751
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13618765
CAQH
OK
05
—
200506310-A
—
OK
Enumeration date
08/23/2013
Last updated
05/26/2020
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