Healthcare Provider Details

I. General information

NPI: 1649055377
Provider Name (Legal Business Name): KYLE MOSLEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 GEORGIA HIGHWAY 20 SE STE 114
CONYERS GA
30013-2076
US

IV. Provider business mailing address

530 SUGAR VALLEY TRL SE
CONYERS GA
30094-3826
US

V. Phone/Fax

Practice location:
  • Phone: 405-312-5648
  • Fax:
Mailing address:
  • Phone: 405-312-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: