Provider Demographics
NPI:1417380817
Name:MOORE, LINDSAY R (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:R
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2707
Mailing Address - Country:US
Mailing Address - Phone:765-481-2260
Mailing Address - Fax:
Practice Address - Street 1:110 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2707
Practice Address - Country:US
Practice Address - Phone:765-481-2260
Practice Address - Fax:765-481-2261
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-13-13485103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst