Provider Demographics
NPI:1982869913
Name:MOONEY, KRISTINE NICOLE (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:NICOLE
Last Name:MOONEY
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:MISS
Other - First Name:KRISTINE
Other - Middle Name:NICOLE
Other - Last Name:DEACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2487 S GILBERT RD STE 106-153
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2807
Mailing Address - Country:US
Mailing Address - Phone:480-744-5286
Mailing Address - Fax:
Practice Address - Street 1:2487 S GILBERT RD STE 106-153
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295
Practice Address - Country:US
Practice Address - Phone:480-744-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-106103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst