Provider Demographics
NPI:1447740485
Name:MOYER, THOMAS ELLIOTT (BCBA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ELLIOTT
Last Name:MOYER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 FAIRPLAY RD
Practice Address - Street 2:
Practice Address - City:TOWNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29689-2907
Practice Address - Country:US
Practice Address - Phone:864-933-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17-39839106S00000X
1-24-70498103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician