MEDICARE: CHERYL MOSS M.A. MFT

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	30603	CA

General Provider Information

NPI Number	:	1700112802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL MOSS M.A. MFT

Provider Business Mailing Address
First Line	:	PO BOX 1381
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-1381
Country	:	US
Telephone Number	:	310-880-1737
Fax Number	:

Provider Business Practice Location Address
First Line	:	9711 WASHINGTON BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2721
Country	:	US
Telephone Number	:	310-880-1737
Fax Number	:

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

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	10/23/2009

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