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NPI Code Detail

MEDICARE: MICHAEL MOORE MA, LADC

MEDICARE: MICHAEL MOORE MA, LADC
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) Counselor888OK

General Provider Information

NPI Number : 1730468927
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL MOORE MA, LADC
Provider Business Mailing Address
First Line : PO BOX 307
Second Line :
City : SPENCER
State : OK
Zip : 73084-0307
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 SE 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73129-7307
Country : US
Telephone Number : 405-672-3033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2011
Last Update Date : 08/05/2011

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