Healthcare Provider Details

I. General information

NPI: 1336363100
Provider Name (Legal Business Name): BOBBIE JUNE MOORE M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOBBIE JUNE SADLER BA, BHRS, CMD

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 N 16TH AVE
DURANT OK
74701-2134
US

IV. Provider business mailing address

608 HWY 271 NORTH
ANTLERS OK
74523
US

V. Phone/Fax

Practice location:
  • Phone: 580-634-2332
  • Fax:
Mailing address:
  • Phone: 580-298-5062
  • Fax: 580-298-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: