Provider Demographics
NPI:1487204418
Name:MOODY, ALYSSA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 W SAHARA AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2753
Mailing Address - Country:US
Mailing Address - Phone:702-427-3825
Mailing Address - Fax:512-260-7220
Practice Address - Street 1:7730 W SAHARA AVE STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2753
Practice Address - Country:US
Practice Address - Phone:702-427-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA0624103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1-22-57773OtherBACB
NVLBA0624OtherSTATE OF NEVADA BOARD OF APPLIED BEHAVIOR ANALYSIS