Provider Demographics
NPI:1225203615
Name:MOORE, LOU ANN (LPC, MED, NCC, NCSC)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, MED, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 GLACIER LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4662
Mailing Address - Country:US
Mailing Address - Phone:405-202-2583
Mailing Address - Fax:
Practice Address - Street 1:2500 S BROADWAY
Practice Address - Street 2:BUILDING 1, SUITE 110
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4038
Practice Address - Country:US
Practice Address - Phone:405-202-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional