Provider Demographics
NPI:1205433067
Name:MOON, BRITTANY MARIE
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MARIE
Last Name:MOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 RED FIR ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2864
Mailing Address - Country:US
Mailing Address - Phone:702-886-7693
Mailing Address - Fax:
Practice Address - Street 1:6671 LAS VEGAS BLVD S STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3273
Practice Address - Country:US
Practice Address - Phone:310-406-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician