Provider Demographics
NPI:1316216989
Name:MOORE, RENATA
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 W LINDSEY ST
Mailing Address - Street 2:APT D
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4268
Mailing Address - Country:US
Mailing Address - Phone:405-473-1778
Mailing Address - Fax:
Practice Address - Street 1:2059 W LINDSEY ST
Practice Address - Street 2:APT D
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4268
Practice Address - Country:US
Practice Address - Phone:405-473-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health