Healthcare Provider Details

I. General information

NPI: 1225874415
Provider Name (Legal Business Name): MICHELLE MOSES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 168
GLENDALE AZ
85308-4624
US

IV. Provider business mailing address

26557 W TARO DR
BUCKEYE AZ
85396-5788
US

V. Phone/Fax

Practice location:
  • Phone: 844-385-3747
  • Fax: 480-462-2801
Mailing address:
  • Phone: 949-412-4164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20068
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: