Provider Demographics
NPI:1588978696
Name:MOOCK, SUSAN Y (BA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:Y
Last Name:MOOCK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:MOOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14006
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-0006
Mailing Address - Country:US
Mailing Address - Phone:405-641-7286
Mailing Address - Fax:
Practice Address - Street 1:11717 TWISTED OAK RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5611
Practice Address - Country:US
Practice Address - Phone:405-641-7286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst