MEDICARE: FULL MOON FOUNDATIONS ABA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1407711781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL MOON FOUNDATIONS ABA LLC

Provider Business Mailing Address
First Line	:	717 MAIN ST # 38
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 MAIN ST # 38
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-4658
Country	:	US
Telephone Number	:	501-515-4701
Fax Number	:

Authorized Official
Title or Position	:	OWNER & BCBA
Name	:	JULIA HOWARD
Credential	:	BCBA, LBA, IBA
Telephone Number	:	501-515-4701

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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