Provider Demographics
NPI:1346562501
Name:MOORE, GABRIELE ELAINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELE
Middle Name:ELAINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S SANTA FE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6210
Mailing Address - Country:US
Mailing Address - Phone:405-255-1152
Mailing Address - Fax:
Practice Address - Street 1:515 S SANTA FE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6210
Practice Address - Country:US
Practice Address - Phone:405-255-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional