Provider Demographics
NPI:1346562311
Name:MOORE, HEATHER A (MS)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS
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Mailing Address - Street 1:6301 CAMPUS CIRCLE DRIVE EAST
Mailing Address - Street 2:BEHAVIORAL INNOVATIONS SUITE 100A
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:469-374-0700
Mailing Address - Fax:469-374-0800
Practice Address - Street 1:6301 CAMPUS CIRCLE DRIVE EAST
Practice Address - Street 2:BEHAVIORAL INNOVATIONS SUITE 100A
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:469-374-0700
Practice Address - Fax:469-374-0800
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4203103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst