Healthcare Provider Details

I. General information

NPI: 1134340094
Provider Name (Legal Business Name): VANESSA FLOY MOYER MS, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/30/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD
OKLAHOMA CITY OK
73106-6835
US

IV. Provider business mailing address

101 WEST PLATT
YUKON OK
73099-3205
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6710
  • Fax: 405-601-6711
Mailing address:
  • Phone: 405-982-4321
  • Fax: 405-601-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1259
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: