Basic Information
| Provider Information | |||||||||
| NPI: | 1306103460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | DEL CARMEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4436 NW 50TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731122212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802501222 | ||||||||
| FaxNumber: | 5802501795 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 SW C AVE | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735014331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802501222 | ||||||||
| FaxNumber: | 5802501795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 04/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.