Healthcare Provider Details

I. General information

NPI: 1083004204
Provider Name (Legal Business Name): WHITNEY MOORE LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PENN AVE
BARTLESVILLE OK
74003-3847
US

IV. Provider business mailing address

8802 N 136TH EAST AVE
OWASSO OK
74055-4799
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-8080
  • Fax:
Mailing address:
  • Phone: 918-729-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number07332
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: