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General NPI Number Information
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NPI Number | 1093588683
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Entity Type | Individual
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Provider Name | KRISTIN JILL MOERY LADC-MH CANDIDATE
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Gender | Female
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 300 W CHEROKEE AVE STE 102
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City | ENID
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State | OK
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Zip | 73701-5600
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Country | US
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Telephone | 580-340-7235
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Fax | 580-324-6324
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Provider Business Mailing Address
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Address Line | 16 COUNTRY CLUB DR
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City | HENNESSEY
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State | OK
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Zip | 73742-9799
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Country | US
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Telephone | 405-853-1184
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CANDIDATE
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License Number State | OK
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