Provider Demographics
NPI:1881948420
Name:BERNARD MOON, LAURA (M ED, BCBA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:BERNARD MOON
Suffix:
Gender:F
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 SANCHEZ ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1640
Mailing Address - Country:US
Mailing Address - Phone:763-439-0303
Mailing Address - Fax:
Practice Address - Street 1:1603 SANCHEZ ST
Practice Address - Street 2:UNIT A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1640
Practice Address - Country:US
Practice Address - Phone:763-439-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-11847103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst