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General NPI Number Information
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NPI Number | 1487467718
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Entity Type | Individual
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Provider Name | JAHLIA MOORE
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 7208 DOBSON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2128
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Country | US
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Telephone | 317-654-6806
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Fax |
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Provider Business Mailing Address
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Address Line | 8275 HEATHERTON CIR APT D
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-1437
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Country | US
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Telephone | 463-250-4850
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-264395
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License Number State | IN
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