Healthcare Provider Details

I. General information

NPI: 1073838298
Provider Name (Legal Business Name): KRISTINA LOUISE MOSLEY M ED. BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST SUITE 505
TACOMA WA
98409-7264
US

IV. Provider business mailing address

116 12TH AVE E
SEATTLE WA
98102-5804
US

V. Phone/Fax

Practice location:
  • Phone: 253-671-9909
  • Fax:
Mailing address:
  • Phone: 120-660-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-6400
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: