=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891824983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANNA N. MOSES PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 HOLLY HILLS AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63111-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-353-5190
-----------------------------------------------------
Fax | 314-353-1310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 HOLLY HILLS AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63111-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-353-5190
-----------------------------------------------------
Fax | 314-353-1310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 06-29P
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2007028984
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------