Healthcare Provider Details

I. General information

NPI: 1679063895
Provider Name (Legal Business Name): TREVA ANN MOSHER CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 COURT ST
PORTSMOUTH OH
45662-3932
US

IV. Provider business mailing address

411 COURT ST
PORTSMOUTH OH
45662-3932
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-6685
  • Fax:
Mailing address:
  • Phone: 740-354-6685
  • Fax: 740-876-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.175301
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberQMHS
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2305008
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: