Healthcare Provider Details

I. General information

NPI: 1811214190
Provider Name (Legal Business Name): MARCIA S. MOORE, PH.D., PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD STE. 221
OKLAHOMA CITY OK
73120-8366
US

IV. Provider business mailing address

4140 W MEMORIAL RD STE. 221
OKLAHOMA CITY OK
73120-8366
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-5801
  • Fax: 405-755-5949
Mailing address:
  • Phone: 405-755-5801
  • Fax: 405-755-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number415
License Number StateOK

VIII. Authorized Official

Name: DR. MARCIA S. MOORE
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 405-755-5801