Provider Demographics
NPI:1205639325
Name:MOORE BEHAVIORAL, LLC
Entity type:Organization
Organization Name:MOORE BEHAVIORAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN-MARK
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-655-9223
Mailing Address - Street 1:3661 HAWKS LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9654
Mailing Address - Country:US
Mailing Address - Phone:904-655-9223
Mailing Address - Fax:
Practice Address - Street 1:3661 HAWKS LANDING CIR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-9654
Practice Address - Country:US
Practice Address - Phone:904-655-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty