Individual
LUCAS MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3105 LAKESHORE DR STE A1013105, ANCHORAGE, AK 99517-2815
(907) 302-9164
Mailing address
PO BOX 241224, ANCHORAGE, AK 99524-1224
(907) 302-9164
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-234032
—
Other
Enumeration date
09/09/2022
Last updated
09/09/2022
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