Healthcare Provider Details

I. General information

NPI: 1346490075
Provider Name (Legal Business Name): LYNN HORNETT-MOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ORCHARD AVE
HOOPA CA
95546-1267
US

IV. Provider business mailing address

2 ORCHARD AVE
HOOPA CA
95546-1267
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-4236
  • Fax: 530-625-4258
Mailing address:
  • Phone: 530-625-4236
  • Fax: 530-625-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM13986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: