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General NPI Number Information
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NPI Number | 1124796065
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Entity Type | Individual
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Provider Name | NICOLE MOES MA, BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/04/2021
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Last Update Date | 09/04/2021
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Provider Practice Location Address
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Address Line | 5521 W LINCOLN HWY STE 101
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City | CROWN POINT
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State | IN
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Zip | 46307-1118
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Country | US
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Telephone | 219-359-3272
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Fax | 219-359-3089
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Provider Business Mailing Address
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Address Line | 114 PLUM CREEK DR APT 2N
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City | SCHERERVILLE
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State | IN
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Zip | 46375-1133
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Country | US
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Telephone | 219-218-8009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-53013
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License Number State | IN
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