Healthcare Provider Details

I. General information

NPI: 1336805076
Provider Name (Legal Business Name): JOCELYN NOELLE MOODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 W SAHARA AVE
LAS VEGAS NV
89117-2798
US

IV. Provider business mailing address

7261 W CHARLESTON BLVD STE 101
LAS VEGAS NV
89117-1679
US

V. Phone/Fax

Practice location:
  • Phone: 702-660-2005
  • Fax:
Mailing address:
  • Phone: 702-396-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA1018
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: