Provider Demographics
NPI:1174167019
Name:MOOS, AMANDA LEE (RBT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:MOOS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7927 N GLEN DR APT 1047
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8008
Mailing Address - Country:US
Mailing Address - Phone:469-796-7251
Mailing Address - Fax:
Practice Address - Street 1:152 BRAND STE 200
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-3717
Practice Address - Country:US
Practice Address - Phone:469-596-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB462132106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician