Provider Demographics
NPI:1578031092
Name:MORENO, EVERARDO ALEXANDER (BCBA)
Entity Type:Individual
Prefix:
First Name:EVERARDO
Middle Name:ALEXANDER
Last Name:MORENO
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 1:1805 ROYAL LN STE 115
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-7520
Mailing Address - Country:US
Mailing Address - Phone:214-778-1153
Mailing Address - Fax:
Practice Address - Street 1:1805 ROYAL LN STE 115
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-7520
Practice Address - Country:US
Practice Address - Phone:214-708-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1744299106S00000X
TX5764103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician