1356533053 NPI number — JUDITH LYNNE MOSS LPC

Table of content: JUDITH LYNNE MOSS LPC (NPI 1356533053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356533053 NPI number — JUDITH LYNNE MOSS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSS
Provider First Name:
JUDITH
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356533053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2725 NORTH WESTWOOD BLVD. SUITE 8
Provider Second Line Business Mailing Address:
LIVING BETTER BEHAVIORAL HEALTH, LLC
Provider Business Mailing Address City Name:
POPLAR BLUFF
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-785-5224
Provider Business Mailing Address Fax Number:
573-776-1464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2725 N WESTWOOD BLVD STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-785-5224
Provider Business Practice Location Address Fax Number:
573-776-1464
Provider Enumeration Date:
08/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  002772 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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