Provider Demographics
NPI:1942856984
Name:MOORE, BIANCA LYNN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 MIDDLEFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7937
Mailing Address - Country:US
Mailing Address - Phone:303-795-2061
Mailing Address - Fax:
Practice Address - Street 1:5941 MIDDLEFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7937
Practice Address - Country:US
Practice Address - Phone:303-795-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 101YM0800X
CO1-19-38984103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty