MEDICARE: MS. MARGIE REE MOSELEY

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1316148042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGIE REE MOSELEY

Provider Business Mailing Address
First Line	:	901 N PACIFIC COAST HWY
Second Line	:	STE 200A-204A
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2162
Country	:	US
Telephone Number	:	310-316-1610
Fax Number	:	310-316-4209

Provider Business Practice Location Address
First Line	:	901 N PACIFIC COAST HWY
Second Line	:	STE 200A-204A
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2162
Country	:	US
Telephone Number	:	310-316-1610
Fax Number	:	310-316-4209

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/10/2011

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