Individual
MELISSA JILL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED, BCBA, LBA
Contact information
Practice address
799 E BRANNON RD, NICHOLASVILLE, KY 40356-6038
(859) 224-2273
(859) 224-4675
Mailing address
109 WIND HAVEN DR STE 100, NICHOLASVILLE, KY 40356-8010
(859) 224-2273
(859) 224-4675
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
269955
KY
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-21-48510
BCBA CERTIFICATE
—
Enumeration date
04/13/2021
Last updated
11/07/2022
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