Healthcare Provider Details

I. General information

NPI: 1285570333
Provider Name (Legal Business Name): MEGAN RENE MOON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13659 E 104TH AVE UNIT 100
COMMERCE CITY CO
80022-9402
US

IV. Provider business mailing address

13659 E 104TH AVE UNIT 100
COMMERCE CITY CO
80022-9402
US

V. Phone/Fax

Practice location:
  • Phone: 303-954-0810
  • Fax:
Mailing address:
  • Phone: 303-954-0810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89274
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: