Provider Demographics
NPI:1861991465
Name:MOORE RESTORED, INC
Entity type:Organization
Organization Name:MOORE RESTORED, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-863-6115
Mailing Address - Street 1:9041 NW 81ST ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8825
Mailing Address - Country:US
Mailing Address - Phone:405-863-6115
Mailing Address - Fax:
Practice Address - Street 1:4200 PERIMETER CENTER DR STE 245
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2322
Practice Address - Country:US
Practice Address - Phone:405-863-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty