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General NPI Number Information
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NPI Number | 1215060538
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Entity Type | Individual
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Provider Name | NAN MOSS LCPC, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 1509 N WHITLEY DR STE 11
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City | FRUITLAND
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State | ID
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Zip | 83619-2260
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Country | US
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Telephone | 541-212-3151
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Fax | 208-452-1232
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Provider Business Mailing Address
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Address Line | PO BOX 971
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City | ONTARIO
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State | OR
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Zip | 97914-0971
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Country | US
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Telephone | 541-212-3151
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Fax | 208-452-1232
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C1279
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-120
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License Number State | ID
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