Provider Demographics
NPI:1114367646
Name:MOORE, RONALD LYNN SR (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LYNN
Last Name:MOORE
Suffix:SR
Gender:M
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-8639
Mailing Address - Country:US
Mailing Address - Phone:405-408-9723
Mailing Address - Fax:
Practice Address - Street 1:5720 OAKWOOD ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-8639
Practice Address - Country:US
Practice Address - Phone:405-408-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200025790-BMedicaid