Healthcare Provider Details

I. General information

NPI: 1508238122
Provider Name (Legal Business Name): ASHLEY MARIE MOSS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 CENTRAL AVE
MONROE LA
71203-6156
US

IV. Provider business mailing address

9403 MANSFIELD RD
SHREVEPORT LA
71118-3815
US

V. Phone/Fax

Practice location:
  • Phone: 318-340-1535
  • Fax:
Mailing address:
  • Phone: 318-861-8938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13179
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: