MEDICARE: JEFF A. MOODY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	902	OK

General Provider Information

NPI Number	:	1073749768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFF A. MOODY, PLLC

Provider Business Mailing Address
First Line	:	3501 NW 63RD ST
Second Line	:	SUITE 404
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-2237
Country	:	US
Telephone Number	:	405-620-3508
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 NW 63RD ST
Second Line	:	SUITE 404
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-2237
Country	:	US
Telephone Number	:	405-620-3508
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. JEFFREY ALLEN MOODY
Credential	:	M.S.
Telephone Number	:	405-620-3508

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	06/08/2009

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