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General NPI Number Information
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NPI Number | 1033409099
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Entity Type | Individual
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Provider Name | SHAWNA DONISE MOORE PSYD, LPC, BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 614 S MAIN ST
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City | STILLWATER
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State | OK
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Zip | 74074-4059
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Country | US
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Telephone | 405-824-3408
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Fax | 405-564-0062
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Provider Business Mailing Address
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Address Line | 2118 N MANNING ST
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City | STILLWATER
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State | OK
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Zip | 74075-2950
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Country | US
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Telephone | 405-824-3408
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Fax | 405-564-0062
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-15017996
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4885
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License Number State | OK
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