Provider Demographics
NPI:1396616926
Name:MOORE, AUDRA (BCBA)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
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 1:6830 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3966
Mailing Address - Country:US
Mailing Address - Phone:216-282-1234
Mailing Address - Fax:216-923-0183
Practice Address - Street 1:225 HERITAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1363
Practice Address - Country:US
Practice Address - Phone:216-282-1234
Practice Address - Fax:216-923-0183
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-25-81991103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst