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General NPI Number Information
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NPI Number | 1578031092
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Entity Type | Individual
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Provider Name | EVERARDO ALEXANDER MORENO BCBA
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Gender | Male
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 9713 SIERRA GRANDE DR
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City | FORT WORTH
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State | TX
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Zip | 76140-4756
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Country | US
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Telephone | 214-708-8621
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Fax | 214-975-2577
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Provider Business Mailing Address
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Address Line | 9713 SIERRA GRANDE DR
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City | FORT WORTH
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State | TX
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Zip | 76140-4756
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Country | US
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Telephone | 214-778-1153
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Fax | 214-975-2577
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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 | 5764
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1744299
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License Number State | TX
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