Provider Demographics
NPI:1083746903
Name:MOORE, ROBERT MONTGOMERY (MHR, LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MONTGOMERY
Last Name:MOORE
Suffix:
Gender:M
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MCSHA PL
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3863
Mailing Address - Country:US
Mailing Address - Phone:405-650-6028
Mailing Address - Fax:
Practice Address - Street 1:2201 WESTPARK DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4012
Practice Address - Country:US
Practice Address - Phone:405-579-4111
Practice Address - Fax:405-579-4223
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3372101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor