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General NPI Number Information
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NPI Number | 1861687642
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Entity Type | Individual
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Provider Name | DOUG MOSER M.A., L.L.P.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 1105 6TH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2345
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Country | US
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Telephone | 231-935-6461
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Fax | 231-935-6920
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Provider Business Mailing Address
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Address Line | 230 W 16TH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4120
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Country | US
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Telephone | 231-946-7930
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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 | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | L1152057
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License Number State | MI
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