Healthcare Provider Details

I. General information

NPI: 1407023740
Provider Name (Legal Business Name): KELLY PAIGE MOSS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIRCLE EVANS ARMY COMM HOSP BEHAVIORAL HEALTH 4TH FLOOR
APO AA
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIRCLE EVANS ARMY COMM HOSP BEHAVIORAL HEALTH 4TH FLOOR
APO AA
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-8411
  • Fax:
Mailing address:
  • Phone: 719-526-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5907345-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: