Provider Demographics
NPI:1205056546
Name:MOORE ALCOHOL AND DRUG CENTER
Entity type:Organization
Organization Name:MOORE ALCOHOL AND DRUG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OUTPATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:405-799-3379
Mailing Address - Street 1:624 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3924
Mailing Address - Country:US
Mailing Address - Phone:405-799-3379
Mailing Address - Fax:405-799-0912
Practice Address - Street 1:624 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3924
Practice Address - Country:US
Practice Address - Phone:405-799-3379
Practice Address - Fax:405-799-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health