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General NPI Number Information
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NPI Number | 1437623238
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Entity Type | Individual
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Provider Name | SAMANTHA MOORHOUSE BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 11930 AMARGOSA ROAD #1075 SUITE 1
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City | VICTORVILLE
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State | CA
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Zip | 92392
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Country | US
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Telephone | 734-478-1809
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Fax | 912-415-8053
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Provider Business Mailing Address
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Address Line | 103 W GENERAL SCREVEN WAY STE G
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City | HINESVILLE
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State | GA
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Zip | 31313-3053
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Country | US
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Telephone | 734-478-1809
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Fax | 912-415-8053
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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 | 1-19-39299
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License Number State |
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