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General NPI Number Information
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NPI Number | 1174740815
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Entity Type | Organization
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Legal Business Name | MOSER FAMILY THERAPY
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 343 E DUVAL ST SUITE 101
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City | LAKE CITY
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State | FL
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Zip | 32055-4088
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Country | US
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Telephone | 386-752-7116
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Fax | 386-752-7188
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Provider Business Mailing Address
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Address Line | 343 E DUVAL ST SUITE 101
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City | LAKE CITY
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State | FL
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Zip | 32055-4088
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Country | US
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Telephone | 386-752-7116
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Fax | 386-752-7188
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JOHN MARK MOSER
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Credential | M.S.W.
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Telephone | 386-752-7116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW3423
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1085
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW1823
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License Number State | FL
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