MEDICARE: MS. TRACEE MOSS MS IN ED

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	101Y00000X	Counselor	E-0004017	OH
2	101YM0800X	Mental Health Counselor	E-0004017	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24875600	OTHER	OH	MIS # MAGELLAN HEALTH SER

General Provider Information

NPI Number	:	1184641730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACEE MOSS MS IN ED

Provider Business Mailing Address
First Line	:	3050 SOUTHWIND TRL
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-2880
Country	:	US
Telephone Number	:	330-953-1202
Fax Number	:	330-953-1204

Provider Business Practice Location Address
First Line	:	3050 SOUTHWIND TRL
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-2880
Country	:	US
Telephone Number	:	330-953-1202
Fax Number	:	330-953-1204

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/06/2022

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