Individual
TIFFANY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 LAKE HOLLINGSWORTH DR, LAKELAND, FL 33803-2364
(863) 665-7300
Mailing address
PO BOX 93374, LAKELAND, FL 33804-3374
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
RBT-18-49175
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019102000
—
FL
Enumeration date
02/20/2018
Last updated
05/26/2022
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