Individual
MELINDA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
Mailing address
PO BOX 1030, ANTLERS, OK 74523-1030
(580) 298-2830
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Enumeration date
06/18/2007
Last updated
06/05/2012
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