Individual
STEPHANIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3205 N DUSTIN AVE, FARMINGTON, NM 87401-9229
(505) 402-1224
Mailing address
907 N ORCHARD AVE, FARMINGTON, NM 87401-6099
(505) 402-1224
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/16/2020
Last updated
04/16/2020
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