MEDICARE: CHESTINA MOORE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1831518562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHESTINA MOORE

Provider Business Mailing Address
First Line	:	9121 N COUNCIL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-1300
Country	:	US
Telephone Number	:	405-470-3422
Fax Number	:	405-470-3428

Provider Business Practice Location Address
First Line	:	9121 N COUNCIL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-1300
Country	:	US
Telephone Number	:	405-470-3422
Fax Number	:	405-470-3428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	04/09/2014

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Directions to “ CHESTINA MOORE ” Practice Location

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