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NPI Code Detail

MEDICARE: ELIZABETH ANN MOORE MA, LADC-MH

MEDICARE: ELIZABETH ANN MOORE MA, LADC-MH
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
1101YA0400XAddiction (Substance Use Disorder) Counselor891OK

General Provider Information

NPI Number : 1528245065
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ANN MOORE MA, LADC-MH
Provider Business Mailing Address
First Line : PO BOX 30301
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73140-3301
Country : US
Telephone Number : 405-514-0727
Fax Number :
Provider Business Practice Location Address
First Line : 4400 N LINCOLN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-5104
Country : US
Telephone Number : 405-424-7711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2008
Last Update Date : 01/08/2026

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