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General NPI Number Information
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NPI Number | 1912469115
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Entity Type | Organization
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Legal Business Name | MOSS THERAPY AND WELLNESS, PLLC
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 17350 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2929
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Country | US
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Telephone | 248-893-7308
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 721161
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City | BERKLEY
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State | MI
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Zip | 48072-0161
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KANDICE MOSS
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Credential | LLPC
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Telephone | 248-893-7308
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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