Healthcare Provider Details

I. General information

NPI: 1508827064
Provider Name (Legal Business Name): CHRISTINA MOSELLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 W EISENHOWER BLVD
LOVELAND CO
80537-3942
US

IV. Provider business mailing address

525 W OAK ST
FORT COLLINS CO
80521-2612
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-9870
  • Fax: 970-613-4475
Mailing address:
  • Phone: 970-494-4300
  • Fax: 970-494-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2464
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: