Doctor Name: | LADENA CAROL MOORE |
NPI Number: | 1083945208 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC NCC |
License Number: | 3702 |
Business Practice Address: | 212 S E 1st Pryor, OK - 74361 |
Business Phone Number: | 9188254115 |
Business Fax Number: | 9188256612 |
Mailing Address: | Po Box 912, PRYOR |
State: | OK |
Postal Code: | 743620912 |
Phone Number: | 9188254115 |
Fax Number: | 9188256612 |
NPI Enumeration Date: | 01/28/2010 |
NPI Last Update Date: | 01/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3702 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |