Provider Demographics
NPI:1881803526
Name:MOORE, ROBIN LEE (MBS, LPC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MBS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 12978
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157
Mailing Address - Country:US
Mailing Address - Phone:405-858-1700
Mailing Address - Fax:
Practice Address - Street 1:2617 GENERAL PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107
Practice Address - Country:US
Practice Address - Phone:405-858-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC 3216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health