Provider Demographics
NPI:1669521217
Name:DENNIS J. MORAN, PH.D. PC
Entity type:Organization
Organization Name:DENNIS J. MORAN, PH.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-681-1227
Mailing Address - Street 1:1601 SW 89TH ST
Mailing Address - Street 2:SUITE B-100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6349
Mailing Address - Country:US
Mailing Address - Phone:405-681-1227
Mailing Address - Fax:405-681-1228
Practice Address - Street 1:1601 SW 89TH ST
Practice Address - Street 2:SUITE B-100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6349
Practice Address - Country:US
Practice Address - Phone:405-681-1227
Practice Address - Fax:405-681-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK446520162-002OtherBCBS PIN
OK244435701Medicare PIN