Provider Demographics
NPI:1598087488
Name:MOORE, ANDREA BERNICE (BS CASE MANAGER)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:BERNICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:BS CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 NW 22ND ST APT C
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-2232
Mailing Address - Country:US
Mailing Address - Phone:580-248-3069
Mailing Address - Fax:
Practice Address - Street 1:2407 NW 22ND ST APT C
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2232
Practice Address - Country:US
Practice Address - Phone:580-248-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor