Individual
MICHAEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LADC
Contact information
Practice address
1301 SE 59TH ST, OKLAHOMA CITY, OK 73129-7307
(405) 672-3033
Mailing address
PO BOX 307, SPENCER, OK 73084-0307
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
888
OK
Other
Enumeration date
08/05/2011
Last updated
08/05/2011
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