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NPI Code Detail

MEDICARE: ANDREA MORGAN MOORE BCBA

MEDICARE: ANDREA MORGAN MOORE BCBA
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
1103K00000XBehavior Analyst1-23-67039MI

General Provider Information

NPI Number : 1275319709
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA MORGAN MOORE BCBA
Provider Business Mailing Address
First Line : 7215 WESTSHIRE DR
Second Line :
City : LANSING
State : MI
Zip : 48917-9764
Country : US
Telephone Number : 517-657-2638
Fax Number : 248-712-4381
Provider Business Practice Location Address
First Line : 7215 WESTSHIRE DR
Second Line :
City : LANSING
State : MI
Zip : 48917-9764
Country : US
Telephone Number : 517-657-2638
Fax Number : 248-712-4381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2023
Last Update Date : 05/11/2026

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