| |
412 N Telephone Rd Moore OK 73160-4920 | |
(405) 794-5552 | |
(405) 759-2402 |
Full Name | |
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Speciality | Counselor |
Location | 412 N Telephone Rd, Moore, Oklahoma |
Authorized Official Name and Position | Gloria J Mccreary (OWNER) |
Authorized Official Contact | 4057945552 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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412 N Telephone Rd Moore OK 73160-4920 Ph: (405) 794-5552 | 412 N Telephone Rd Moore OK 73160-4920 Ph: (405) 794-5552 |
NPI Number | 1871622217 |
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Provider Enumeration Date | 03/02/2007 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 7810035235 |
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Medicare Enrollment ID | O20240321001664 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871622217 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Gloria Jean Mccreary |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1497797336 PECOS PAC ID: 1153469572 Enrollment ID: I20240321001772 |
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