Healthcare Provider Details

I. General information

NPI: 1871287276
Provider Name (Legal Business Name): MEGAN LYNN MOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 S 7 HWY
BLUE SPRINGS MO
64014-3539
US

IV. Provider business mailing address

824 NE LYON CT
LEES SUMMIT MO
64086-1712
US

V. Phone/Fax

Practice location:
  • Phone: 816-308-0246
  • Fax: 816-566-0486
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2013032507
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2023015706
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: