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General NPI Number Information
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NPI Number | 1356009393
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Entity Type | Individual
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Provider Name | SHANTELL MOSLEY LAMFT
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Gender | Female
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 7400 HANCOCK CT NE STE D
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4592
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Country | US
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Telephone | 817-448-1635
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Fax |
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Provider Business Mailing Address
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Address Line | 3852 GERMAN POINTER WAY
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City | FORT WORTH
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State | TX
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Zip | 76123-3500
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Country | US
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Telephone | 181-744-8163
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T-CTL0221321
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License Number State | NM
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