Provider Demographics
NPI:1427140219
Name:MOORE COUNSELING CENTER, P.C.
Entity type:Organization
Organization Name:MOORE COUNSELING CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:GANT
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-735-6333
Mailing Address - Street 1:604 S CLASSEN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5401
Mailing Address - Country:US
Mailing Address - Phone:405-735-6333
Mailing Address - Fax:405-735-6629
Practice Address - Street 1:604 S CLASSEN AVE
Practice Address - Street 2:STE A
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5401
Practice Address - Country:US
Practice Address - Phone:405-735-6333
Practice Address - Fax:405-735-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty