Provider Demographics
NPI:1437623238
Name:MOORHOUSE, SAMANTHA (BCBA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MOORHOUSE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:RATHFON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W GENERAL SCREVEN WAY STE G
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3053
Mailing Address - Country:US
Mailing Address - Phone:734-478-1809
Mailing Address - Fax:912-415-8053
Practice Address - Street 1:11930 AMARGOSA ROAD
Practice Address - Street 2:#1075 SUITE 1
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392
Practice Address - Country:US
Practice Address - Phone:734-478-1809
Practice Address - Fax:912-415-8053
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-39299103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst