Healthcare Provider Details

I. General information

NPI: 1942736962
Provider Name (Legal Business Name): PATRICIA MOSS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

IV. Provider business mailing address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-0731
  • Fax:
Mailing address:
  • Phone: 614-252-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.991818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: