Provider Demographics
NPI:1386997922
Name:MOORE, JUAN CARLOS
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLOS
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 N COUNCIL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-1300
Mailing Address - Country:US
Mailing Address - Phone:405-408-1216
Mailing Address - Fax:405-470-3428
Practice Address - Street 1:9121 N COUNCIL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-1300
Practice Address - Country:US
Practice Address - Phone:405-408-1216
Practice Address - Fax:405-470-3428
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional