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General NPI Number Information
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NPI Number | 1073749768
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Entity Type | Organization
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Legal Business Name | JEFF A. MOODY, PLLC
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 3501 NW 63RD ST SUITE 404
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-2237
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Country | US
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Telephone | 405-620-3508
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 NW 63RD ST SUITE 404
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-2237
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Country | US
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Telephone | 405-620-3508
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. JEFFREY ALLEN MOODY
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Credential | M.S.
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Telephone | 405-620-3508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 902
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License Number State | OK
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