Provider Demographics
NPI:1861831851
Name:MOORE, TAMARA ALISHA (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ALISHA
Last Name:MOORE
Suffix:
Gender:F
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-8639
Mailing Address - Country:US
Mailing Address - Phone:405-501-7453
Mailing Address - Fax:
Practice Address - Street 1:5720 OAKWOOD ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-8639
Practice Address - Country:US
Practice Address - Phone:405-501-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1962707018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200025790-BMedicaid