Provider Demographics
NPI:1528293784
Name:MOORE, ANDREW EDWARD (LPC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:EDWARD
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 STINCHCOMB DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3818
Mailing Address - Country:US
Mailing Address - Phone:405-361-2027
Mailing Address - Fax:
Practice Address - Street 1:6620 STINCHCOMB DR
Practice Address - Street 2:SUITE 106
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3818
Practice Address - Country:US
Practice Address - Phone:405-361-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional