=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417183930
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK J MOSELY CADTP3
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2009
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 727 FAIRVIEW DR STE A
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89701-5493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-684-5000
-----------------------------------------------------
Fax | 775-687-1181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 727 FAIRVIEW DR STE A
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89701-5493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-684-5000
-----------------------------------------------------
Fax | 775-687-1181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------