Healthcare Provider Details

I. General information

NPI: 1427068931
Provider Name (Legal Business Name): DEBORAH SUE MORAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E MONROE AVE
MCALESTER OK
74501-4815
US

IV. Provider business mailing address

503 DOVE DRIVE
MCALESTER OK
74501-3702
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-7842
  • Fax: 918-426-5526
Mailing address:
  • Phone: 918-302-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number416
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2389
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: