Healthcare Provider Details

I. General information

NPI: 1396080644
Provider Name (Legal Business Name): KELLI L. MOSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 N HUALAPAI WAY STE 145-255
LAS VEGAS NV
89149-1371
US

IV. Provider business mailing address

6720 N HUALAPAI WAY STE 145-255
LAS VEGAS NV
89149-1371
US

V. Phone/Fax

Practice location:
  • Phone: 702-551-9380
  • Fax:
Mailing address:
  • Phone: 916-708-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0629
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: