Provider Demographics
NPI:1023077021
Name:MOODY, RAMONA S (LCSW)
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:S
Last Name:MOODY
Suffix:
Gender:F
Credentials:LCSW
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Other - Credentials:
Mailing Address - Street 1:6655 S YALE AVE
Mailing Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3326
Mailing Address - Country:US
Mailing Address - Phone:918-481-4000
Mailing Address - Fax:918-491-5740
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-481-4000
Practice Address - Fax:918-491-5740
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK22221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2016622OtherCIGNA BEHAVIORAL HEALTH
OKS74463Medicare UPIN