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General NPI Number Information
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NPI Number | 1720974520
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Entity Type | Individual
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Provider Name | ASHTON MOODY
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Gender |
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 421 N SAM RAYBURN FWY
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City | SHERMAN
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State | TX
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Zip | 75090-5863
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Country | US
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Telephone | 214-778-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 2831 W ELDORADO PKWY # 106
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City | LITTLE ELM
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State | TX
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Zip | 75068-3540
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Country | US
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Telephone |
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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 |
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License Number State |
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