Healthcare Provider Details

I. General information

NPI: 1831722065
Provider Name (Legal Business Name): DANIEL GENE MOSLEY LADC/MH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WEST BROADWAY SUITE 410
ARDMORE OK
73401-4322
US

IV. Provider business mailing address

3308 WOODSBORO DR
NORMAN OK
73072-3378
US

V. Phone/Fax

Practice location:
  • Phone: 855-843-6279
  • Fax: 855-843-6279
Mailing address:
  • Phone: 405-446-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1488
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1488
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: