Provider Demographics
NPI:1780974923
Name:MOORE, TOM JOE (BCBA)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:JOE
Last Name:MOORE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 NW 63RD TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6368
Mailing Address - Country:US
Mailing Address - Phone:352-338-2854
Mailing Address - Fax:352-332-8589
Practice Address - Street 1:2405 NW 63RD TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6368
Practice Address - Country:US
Practice Address - Phone:352-338-2854
Practice Address - Fax:352-332-8589
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0585103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-01-0585OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD