Healthcare Provider Details

I. General information

NPI: 1669514378
Provider Name (Legal Business Name): ROXANN RENEE MOELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N DENVER
TULSA OK
74103-1820
US

IV. Provider business mailing address

650 S PEORIA
TULSA OK
74120-4429
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-1200
  • Fax: 918-581-0777
Mailing address:
  • Phone: 918-587-9471
  • Fax: 918-560-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2956
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: