Provider Demographics
NPI:1083113062
Name:MOSHER, PAUL ANDREW JR (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANDREW
Last Name:MOSHER
Suffix:JR
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3758 E 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4434
Mailing Address - Country:US
Mailing Address - Phone:720-205-5375
Mailing Address - Fax:
Practice Address - Street 1:3758 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4434
Practice Address - Country:US
Practice Address - Phone:970-444-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-53768103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst