Doctor Name: | MRS. JERRY LYNN MOORE |
NPI Number: | 1184709073 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS UNDER SUP. LPC |
License Number: | |
Business Practice Address: | 14625 Ne 23rd St. Choctaw, OK - 730200695 |
Business Phone Number: | 4053908131 |
Business Fax Number: | 4053908134 |
Mailing Address: | Po Box 695, CHOCTAW |
State: | OK |
Postal Code: | 730200695 |
Phone Number: | 4053908131 |
Fax Number: | 4053908134 |
NPI Enumeration Date: | 10/26/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |