Basic Information
| Provider Information | |||||||||
| NPI: | 1083746903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MONTGOMERY | ||||||||
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| Credential: | MHR, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 BAILEY CT | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730723864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056506028 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 24TH AVE NW | ||||||||
| Address2: | SUITE E | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053298167 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 06/25/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3372 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.