Provider Demographics
NPI:1992004626
Name:MOORE, LEONDRA ALECIA (LCSW)
Entity Type:Individual
Prefix:
First Name:LEONDRA
Middle Name:ALECIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30232
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0004
Mailing Address - Country:US
Mailing Address - Phone:405-406-8771
Mailing Address - Fax:
Practice Address - Street 1:632 THORN BRIAR RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4276
Practice Address - Country:US
Practice Address - Phone:405-406-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical