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General NPI Number Information
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NPI Number | 1568825107
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Entity Type | Organization
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Legal Business Name | KHARVENA MOSS COUNSELING SERVICES
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 5053 LA MART DR STE 105
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City | RIVERSIDE
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State | CA
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Zip | 92507-5993
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Country | US
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Telephone | 951-500-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 5053 LA MART DR STE 105
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City | RIVERSIDE
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State | CA
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Zip | 92507-5993
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Country | US
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Telephone | 951-500-5777
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | KHARVENA D MOSS
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Credential |
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Telephone | 951-500-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 91939
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License Number State | CA
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