Provider Demographics
NPI:1164548491
Name:MOORE, SARAH NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NICKI
Other - Middle Name:WEBBER
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3212 MEADOW AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-7437
Mailing Address - Country:US
Mailing Address - Phone:405-325-3138
Mailing Address - Fax:405-325-0806
Practice Address - Street 1:180 W BROOKS ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-1018
Practice Address - Country:US
Practice Address - Phone:405-325-3138
Practice Address - Fax:405-325-0806
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK986103TC1900X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports