Provider Demographics
NPI:1689217176
Name:MOORE, LESLIE JUNE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JUNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 WOLFRUM RD
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7795
Mailing Address - Country:US
Mailing Address - Phone:636-685-0720
Mailing Address - Fax:
Practice Address - Street 1:1030 WOLFRUM RD
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-7795
Practice Address - Country:US
Practice Address - Phone:636-685-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst