=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952726101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M MOORE ENTERPRISES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2014
-----------------------------------------------------
Last Update Date | 02/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5929 N MAY AVE SUITE 300
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-223-0738
-----------------------------------------------------
Fax | 405-463-6803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5929 N MAY AVE SUITE 300
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-223-0738
-----------------------------------------------------
Fax | 405-463-6803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MICHAEL MOORE
-----------------------------------------------------
Credential | LADC/MH
-----------------------------------------------------
Telephone | 405-223-0738
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------