Healthcare Provider Details

I. General information

NPI: 1538679972
Provider Name (Legal Business Name): ROSIE MOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 OLIVER RD
MONROE LA
71201-5755
US

IV. Provider business mailing address

1162 OLIVER RD
MONROE LA
71201-5755
US

V. Phone/Fax

Practice location:
  • Phone: 318-340-1535
  • Fax:
Mailing address:
  • Phone: 318-340-1535
  • 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 Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: