| Moore Family Therapy | |
|
400 N Eastern Ave Moore OK 73160-5833 | |
| (405) 659-5858 | |
| Not Available |
| Full Name | Moore Family Therapy |
|---|---|
| Speciality | Clinic/Center |
| Location | 400 N Eastern Ave, Moore, Oklahoma |
| Authorized Official Name and Position | Crystal Rios (OWNER) |
| Authorized Official Contact | 4056595858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moore Family Therapy 625 Valley View Rd Norman OK 73069-9713 Ph: () - | Moore Family Therapy 400 N Eastern Ave Moore OK 73160-5833 Ph: (405) 659-5858 |
| NPI Number | 1821508763 |
|---|---|
| Provider Enumeration Date | 10/05/2017 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 6507212172 |
|---|---|
| Medicare Enrollment ID | O20231102001834 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821508763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1159 (Oklahoma) | Primary |
| Provider Name | Crystal Rios |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1891012522 PECOS PAC ID: 9133575707 Enrollment ID: I20231121003763 |
| Provider Name | Lisa Cooper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083024178 PECOS PAC ID: 9537517750 Enrollment ID: I20231129001610 |
| Provider Name | William White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104267723 PECOS PAC ID: 5092163808 Enrollment ID: I20231204002275 |
| Provider Name | Gerry Wade Funkhouser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427567726 PECOS PAC ID: 9133578016 Enrollment ID: I20231218003170 |
| Provider Name | Debra Dawn Thompson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508068644 PECOS PAC ID: 7810347713 Enrollment ID: I20231218004371 |
| Provider Name | Rosa Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689962037 PECOS PAC ID: 4688027725 Enrollment ID: I20240125001118 |
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Moore Alcohol And Drug Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 624 Nw 5th St, Moore, OK 73160 Phone: 405-799-3379 Fax: 405-799-0912 | |
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