Individual
HEIDI LYNN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
140 S MAIN ST, STILLWATER, OK 74074-3504
(559) 355-6882
Mailing address
14474 S HUDSON AVE, BIXBY, OK 74008-4022
(918) 613-0116
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-25-440140
OK
Other
Enumeration date
05/31/2025
Last updated
05/31/2025
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