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General NPI Number Information
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NPI Number | 1952664021
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Entity Type | Organization
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Legal Business Name | MOSLEY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 2130 W. ARROWHEAD AVE. SUITE 103C
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City | SAN BERNARDINO
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State | CA
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Zip | 92405
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Country | US
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Telephone | 909-723-8290
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Fax | 909-723-8290
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Provider Business Mailing Address
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Address Line | 2130 N. ARROWHEAD AVE SUITE 103C
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City | SAN BERNARDINO
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State | CA
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Zip | 92405
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Country | US
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Telephone | 909-723-8290
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Fax | 909-723-8290
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Authorized Official
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Title or Position | CEO
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Name | LAMAR T MOSLEY
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Credential | COUNSELOR
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Telephone | 909-252-3183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CAVIC2-790-081513B
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License Number State | CA
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