Individual
COLIN LANCE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
1133 W WILSON ST APT E, BATAVIA, IL 60510-1884
(812) 814-0182
(812) 814-0182
Mailing address
1133 W WILSON ST APT E, BATAVIA, IL 60510-1884
(812) 814-0182
(423) 296-4230
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
1-14-0724
IL
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
Other
Enumeration date
01/26/2008
Last updated
01/08/2024
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