Provider Demographics
NPI:1588929384
Name:MOORE, DEBORAH JEAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W GLEN EAGLE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-1547
Mailing Address - Country:US
Mailing Address - Phone:405-570-8476
Mailing Address - Fax:
Practice Address - Street 1:2001 W GLEN EAGLE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-1547
Practice Address - Country:US
Practice Address - Phone:405-570-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2083101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3YIGQGMJVMedicare PIN