Healthcare Provider Details

I. General information

NPI: 1699753004
Provider Name (Legal Business Name): PATRICIA GRACE MOSELEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR
U S A F ACADEMY CO
80840-2502
US

IV. Provider business mailing address

2332 ELITE TER
COLORADO SPRINGS CO
80920-3858
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-1851
  • Fax:
Mailing address:
  • Phone: 719-278-4337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801077715
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: