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NPI Code Detail

MEDICARE: MICHELLE MOSELEY LCSW

MEDICARE: MICHELLE MOSELEY LCSW
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
11041C0700XClinical Social Worker1293-CAR

General Provider Information

NPI Number : 1881636967
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE MOSELEY LCSW
Provider Business Mailing Address
First Line : PO BOX 1589
Second Line :
City : BENTON
State : AR
Zip : 72018-1589
Country : US
Telephone Number : 501-315-3344
Fax Number :
Provider Business Practice Location Address
First Line : 1628 E PAGE AVE
Second Line :
City : MALVERN
State : AR
Zip : 72104-4524
Country : US
Telephone Number : 501-332-4437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 06/21/2011

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Directions to “ MICHELLE MOSELEY LCSW” Practice Location

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