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NPI Code Detail

MEDICARE: MRS. HALEY RAYNE MOON

MEDICARE: MRS. HALEY RAYNE MOON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianBACB804628LA
2103K00000XBehavior AnalystL886LA

General Provider Information

NPI Number : 1174231807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HALEY RAYNE MOON
Provider Business Mailing Address
First Line : 209 INDEPENDENCE DR
Second Line :
City : MANDEVILLE
State : LA
Zip : 70471-8525
Country : US
Telephone Number : 504-610-1623
Fax Number :
Provider Business Practice Location Address
First Line : 2000 COVINGTON CTR
Second Line :
City : COVINGTON
State : LA
Zip : 70433-2979
Country : US
Telephone Number : 985-237-1921
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2022
Last Update Date : 10/01/2024

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