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NPI Code Detail

MEDICARE: MICHELLE LYNN MOODY RASI

MEDICARE: MICHELLE LYNN MOODY RASI
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1740491976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LYNN MOODY RASI
Provider Business Mailing Address
First Line : 440 ARROWOOD DR
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-7503
Country : US
Telephone Number : 707-284-2950
Fax Number : 707-282-2955
Provider Business Practice Location Address
First Line : 440 ARROWOOD DR
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-7503
Country : US
Telephone Number : 707-284-2950
Fax Number : 707-282-2955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2007
Last Update Date : 07/08/2007

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