MEDICARE: HOLLIE LYNN MOORE

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1427998996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLIE LYNN MOORE

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 QUARTERMASTER CT
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3670
Country	:	US
Telephone Number	:	812-258-9802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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