Provider Demographics
NPI:1417382615
Name:MOORE, THOMAS TAYLOR (MA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:TAYLOR
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18202 W 20TH ST N
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:OK
Mailing Address - Zip Code:74436-2800
Mailing Address - Country:US
Mailing Address - Phone:918-639-3903
Mailing Address - Fax:
Practice Address - Street 1:111 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-5301
Practice Address - Country:US
Practice Address - Phone:405-331-2300
Practice Address - Fax:405-331-2302
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional