Healthcare Provider Details

I. General information

NPI: 1437315744
Provider Name (Legal Business Name): GLORIA MOORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S MAIN ST
STILLWATER OK
74074-4631
US

IV. Provider business mailing address

509 E ELM ST
SALINA KS
67401-2353
US

V. Phone/Fax

Practice location:
  • Phone: 405-533-3618
  • Fax: 405-533-3570
Mailing address:
  • Phone: 785-825-0541
  • Fax: 785-825-4024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number780
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: