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General NPI Number Information
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NPI Number | 1164308540
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Entity Type | Individual
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Provider Name | MYLA DENISE MOSS
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Gender | Female
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 20700 CIVIC CENTER DR STE 110
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City | SOUTHFIELD
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State | MI
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Zip | 48076-4102
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Country | US
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Telephone | 800-385-1035
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Fax |
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Provider Business Mailing Address
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Address Line | 20211 WOODLAND ST
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City | HARPER WOODS
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State | MI
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Zip | 48225-2029
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Country | US
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Telephone | 313-210-3829
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 106S00000X
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License Number State | MI
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