Individual provider Active NPI

Heather Renee Moore, MA, LPC

  • Professional Counselor
  • Tulsa, OK
National Provider Identifier
1649604885
Registry record updated May 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5751 Issued in OK
Practice address
550 S Peoria Ave
Tulsa, OK 74120-3820
Phone
(918) 588-1900
Fax
(918) 382-1285
NPI assigned
Aug 23, 2013
Last updated
May 26, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 5751 OK
Professional Counselor 101YP2500X 5751 OK Primary

Addresses

Primary practice location

550 S Peoria Ave
Tulsa, OK 74120-3820

Mailing address

550 S Peoria Ave
Tulsa, OK 74120-3820
Phone (918) 588-1900

Other identifiers 2

IdentifierTypeStateIssuer
13618765OtherOKCAQH
200506310-AMedicaidOK

Other names 1

  • Heather Renee Jones Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240118002399 OK Practitioner - Mental Health Counselor 2860844594 Reassigns benefits to 1 organization
I20250929002356 TX Practitioner - Mental Health Counselor 2860844594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2013
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

18507 E 45TH PL S
Tulsa, OK 74134-5512

550 S Peoria Ave
Tulsa, OK 74120-3820

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
5751OKMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Indian Health Care Resource Center CurrentSince Jan 1, 2024 Accepting new patients
Indian Health Care Resource Center of Tulsa, Inc. PastSince May 31, 2020 Accepting new patients

Locations

550 S Peoria Ave
Tulsa, OK 74120
Phone (918) 382-1207

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1377216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590451200000",
    "number": "1649604885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S PEORIA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741203820",
            "telephone_number": "918-588-1900",
            "fax_number": "918-382-1285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S PEORIA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741203820",
            "telephone_number": "918-588-1900",
            "fax_number": "918-382-1285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "HEATHER",
        "middle_name": "RENEE",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-23",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "5751",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "5751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13618765",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200506310-A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "JONES",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.