Provider Demographics
NPI:1336363100
Name:MOORE, BOBBIE JUNE (BA, PSRS, CMD)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JUNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:BA, PSRS, CMD
Other - Prefix:MISS
Other - First Name:BOBBIE
Other - Middle Name:JUNE
Other - Last Name:SADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, BHRS, CMD
Mailing Address - Street 1:608 HWY 271 NORTH
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523
Mailing Address - Country:US
Mailing Address - Phone:580-298-5062
Mailing Address - Fax:580-298-5072
Practice Address - Street 1:608 HWY 271 NORTH
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523
Practice Address - Country:US
Practice Address - Phone:580-298-5062
Practice Address - Fax:580-298-5072
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200111200AMedicaid