Basic Information
| Provider Information | |||||||||
| NPI: | 1538821822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4418 NW 20TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731073608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058160343 | ||||||||
| FaxNumber: | 4053640342 | ||||||||
| Practice Location | |||||||||
| Address1: | 1181 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730715331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057012177 | ||||||||
| FaxNumber: | 4053640342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2021 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4188 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.