Provider Demographics
NPI:1275273211
Name:MOORE, ALEXANDRIA LOUISE (RBT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:LOUISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N E ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:OK
Mailing Address - Zip Code:74085-3539
Mailing Address - Country:US
Mailing Address - Phone:918-960-4492
Mailing Address - Fax:
Practice Address - Street 1:614 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4059
Practice Address - Country:US
Practice Address - Phone:405-564-3408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-22-208717106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician