Provider Demographics
NPI:1992011357
Name:MOORE, JAMES W (BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:BCBA-D
Other - Prefix:
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Mailing Address - Street 1:118 COLLEGE DR
Mailing Address - Street 2:BOX 5025
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39406-0002
Mailing Address - Country:US
Mailing Address - Phone:601-266-4611
Mailing Address - Fax:601-266-4620
Practice Address - Street 1:118 COLLEGE DR
Practice Address - Street 2:BOX 5025
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406-0002
Practice Address - Country:US
Practice Address - Phone:601-266-4611
Practice Address - Fax:601-266-4620
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1-02-0969103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst