Provider Demographics
NPI:1699168344
Name:MOORE, MARION (PH,D, BCBA-D)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PH,D, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 W ORCHARD TER
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-9144
Mailing Address - Country:US
Mailing Address - Phone:509-990-6986
Mailing Address - Fax:
Practice Address - Street 1:12412 W ORCHARD TER
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-9144
Practice Address - Country:US
Practice Address - Phone:509-990-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-14325103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst