Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Roosevelt Premier Therapy

Organization Mental Health Counselor · NPI 1356188692

Roosevelt Premier Therapy is a Mental Health Counselor in Moore, Oklahoma. Registered with an NPI since 2024.

In the registry since
2024
Specialties on file
10

Practice location Address checks out

1120 N Eastern Ave Ste 108
Moore, OK 73160-5856
Phone: (405) 735-7162
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Analyst (primary) Taxonomy 103K00000X
Mental Health Counselor Taxonomy 101YM0800X
Nutrition Education Nutritionist Taxonomy 133NN1002X
Art Therapist Taxonomy 221700000X
Developmental Therapist Taxonomy 222Q00000X
Physical Therapist Taxonomy 225100000X
Recreation Therapist Taxonomy 225800000X
Music Therapist Taxonomy 225A00000X
Occupational Therapist Taxonomy 225X00000X
Speech-Language Pathologist Taxonomy 235Z00000X

Record details

NPI number1356188692
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Selica Granderson — Director · (601) 331-4463
NPI enumeratedJuly 12, 2024
Last updated in NPPESJuly 15, 2024
Certification dateJuly 15, 2024
Mailing addressPo Box 325, Hutto, TX 78634-0325

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