Healthcare Provider Details

I. General information

NPI: 1730595000
Provider Name (Legal Business Name): JULIE ANN MOSLEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MOOCK RD STE 101
WILDER KY
41071-5465
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9058
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-9333
  • Fax: 859-341-9444
Mailing address:
  • Phone: 859-341-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number242058
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: