Individual
MICHAELA RAE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
410 TEACO RD, KENNETT, MO 63857-3239
(870) 565-9776
Mailing address
410 TEACO RD, KENNETT, MO 63857-3239
(870) 565-9776
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2024045907
MO
106E00000X
Assistant Behavior Analyst
0-23-14253
TN
106S00000X
Behavior Technician
RBT-17-29629
LA
106S00000X
Behavior Technician
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Other
Enumeration date
02/27/2018
Last updated
12/10/2024
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