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General NPI Number Information
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NPI Number | 1760368005
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Entity Type | Individual
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Provider Name | LORI R MOSES LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 201 N RIVERSIDE DR
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City | INDIALANTIC
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State | FL
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Zip | 32903-4274
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Country | US
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Telephone | 321-307-3830
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Fax |
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Provider Business Mailing Address
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Address Line | 2990 S FISKE BLVD APT A1
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City | ROCKLEDGE
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State | FL
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Zip | 32955-3931
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Country | US
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Telephone | 407-694-3786
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH25918
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License Number State | FL
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