Provider Demographics
NPI:1376822502
Name:MORENO, ANGELA LESLIE (MA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LESLIE
Last Name:MORENO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:210 E MAIN
Mailing Address - Street 2:RESOURCE MANAGEMENT
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:4001 N LINCOLN BLVD. OUTPATIENT SERVICES-OKC
Practice Address - Street 2:STRONG FAMILY DEVELOPMENT
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105
Practice Address - Country:US
Practice Address - Phone:405-767-8971
Practice Address - Fax:405-767-8968
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health