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NPI Code Detail

MEDICARE: AD ASTRA BEHAVIOR EXCHANGE, LLC

MEDICARE: AD ASTRA BEHAVIOR EXCHANGE, LLC
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 Analyst

General Provider Information

NPI Number : 1801574926
Entity Type Code : Organization
Provider Name (Legal Business Name) : AD ASTRA BEHAVIOR EXCHANGE, LLC
Provider Business Mailing Address
First Line : 9912 LAVENDER LN
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-1531
Country : US
Telephone Number : 620-791-8418
Fax Number :
Provider Business Practice Location Address
First Line : 9912 LAVENDER LN
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-1531
Country : US
Telephone Number : 620-791-8418
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JULIE MOORE
Credential : MS, BCBA, LBA
Telephone Number : 620-791-8418
Provider Enumeration Date : 07/10/2023
Last Update Date : 07/10/2023

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