Provider Demographics
NPI:1508505256
Name:BEHAVIOR MEDICINE
Entity Type:Organization
Organization Name:BEHAVIOR MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOATES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, QBA, LBA, LCMHC
Authorized Official - Phone:817-999-7534
Mailing Address - Street 1:2700 COLORADO BLVD APT 1526
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6839
Mailing Address - Country:US
Mailing Address - Phone:817-999-7534
Mailing Address - Fax:
Practice Address - Street 1:2700 COLORADO BLVD APT 1526
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6839
Practice Address - Country:US
Practice Address - Phone:817-999-7534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty