Active NPI
Jolisa Moonen, BCBA
- Behavior Analyst
- Tucson, AZ
National Provider Identifier
1730651357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BEH-000412
- Practice address
- 1955 W Grant Rd Ste 180
Tucson, AZ 85745-1475 - Phone
- (844) 333-6642
- Fax
- (520) 333-3060
- NPI assigned
- Dec 20, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BEH-000412 | AZ | Primary |
Addresses
Primary practice location
1955 W Grant Rd Ste 180
Tucson, AZ 85745-1475
Mailing address
1955 W Grant Rd Ste 180
Tucson, AZ 85745-1475
Phone (844) 333-6642
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BEH-000412 | Other | AZ | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BEH-000412 | AZ | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optima Behavioral Consulting, LLC | Behavior Analyst | Past | Accepting new patients |
| Optima Behavioral Consulting, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Tucson, AZ
- NPI 1548658388
-
- Behavior Analyst
- Tucson, AZ
- NPI 1629566351
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545264000000",
"number": "1730651357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1955 W GRANT RD STE 180",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857451475",
"telephone_number": "844-333-6642",
"fax_number": "520-333-3060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1955 W GRANT RD STE 180",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857451475",
"telephone_number": "844-333-6642",
"fax_number": "520-333-3060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOONEN",
"first_name": "JOLISA",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-20",
"last_updated": "2018-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AZ",
"license": "BEH-000412",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "BEH-000412",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.