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General NPI Number Information
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NPI Number | 1700272432
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Entity Type | Organization
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Legal Business Name | SOUTHERN MISS AUTISM RESEARCH TEAM (SMART) CLINIC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 118 COLLEGE DR BOX 5025 UNIVERSITY OF SOUTHERN MISSISSIPPI
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City | HATTIESBURG
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State | MS
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Zip | 39406-0001
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Country | US
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Telephone | 601-266-5025
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Fax |
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Provider Business Mailing Address
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Address Line | 118 COLLEGE DR BOX 5025 UNIVERSITY OF SOUTHERN MISSISSIPPI
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City | HATTIESBURG
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State | MS
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Zip | 39406-0001
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Country | US
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Telephone | 601-266-5025
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | DR. JAMES W MOORE
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Credential | BCBA-D
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Telephone | 601-266-4611
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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 | 1-02-0968
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License Number State | MS
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