Tanisha Penn Moore, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

917 Issued in OK

Practice address

2727 S 137TH West Ave
Sand Springs, OK 74063-5017

Phone

(918) 245-0231

Fax

(918) 241-5031

NPI assigned

Sep 27, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tulsa Boys' Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Sand Springs, OK
  • NPI 1851420384
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1295018034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11106 N 133RD EAST AVE",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740555639",
            "telephone_number": "918-527-3014",
            "fax_number": "918-241-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 S 137TH WEST AVE",
            "city": "SAND SPRINGS",
            "state": "OK",
            "postal_code": "740635017",
            "telephone_number": "918-245-0231",
            "fax_number": "918-241-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN MOORE",
        "first_name": "TANISHA",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-27",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Marie Owens, PHARMD
• Oscar Padron
• David R Parker, LPC
• Brian Dale Patten, DDS
• Tina Marie Patterson
• Pharmacy Corporation of America
• Caroline Phillips Ryan
• Phoenix Residential Services
• Barbara Barger Pinkerton, LPC
• Jami D Pittman, A.R.N.P.

• Addiction (Substance Use Disorder) Counselor in Sand Springs, OK
• Providers in Sand Springs, OK by specialty
• Addiction (Substance Use Disorder) Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.