Provider Demographics
NPI:1386348324
Name:MOORE, SEAN (MDIV, MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MDIV, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NW HEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9535
Mailing Address - Country:US
Mailing Address - Phone:803-447-8938
Mailing Address - Fax:
Practice Address - Street 1:1303 W GORE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3666
Practice Address - Country:US
Practice Address - Phone:580-512-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily