Provider Demographics
NPI:1720465693
Name:MOORMAN, JOHANNA LOUISE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LOUISE
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12726 HAMILTON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5422
Mailing Address - Country:US
Mailing Address - Phone:317-249-2242
Mailing Address - Fax:317-249-2248
Practice Address - Street 1:12726 HAMILTON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5422
Practice Address - Country:US
Practice Address - Phone:317-249-2242
Practice Address - Fax:317-249-2248
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-15-18588103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst