Provider Demographics
NPI:1063862258
Name:MOATES, MICHAEL STEVEN (EDD, LP, LBA, QBA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:MOATES
Suffix:
Gender:M
Credentials:EDD, LP, LBA, QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 COLORADO BLVD APT 1526
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6839
Mailing Address - Country:US
Mailing Address - Phone:817-999-7534
Mailing Address - Fax:
Practice Address - Street 1:5764 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810
Practice Address - Country:US
Practice Address - Phone:179-349-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2023-10-25
Deactivation Date:2022-01-23
Deactivation Code:
Reactivation Date:2022-04-14
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X, 101YP2500X, 103T00000X, 103TC1900X, 103TF0200X, 103TM1800X, 106E00000X, 247200000X
VA0133002387103K00000X
FLTPPY1662103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other