MEDICARE: SHANNON MOSS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2015004094	MO

General Provider Information

NPI Number	:	1013471937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MOSS LPC

Provider Business Mailing Address
First Line	:	2515 LEXINGTON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-1638
Country	:	US
Telephone Number	:	316-208-7833
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 LEXINGTON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-1638
Country	:	US
Telephone Number	:	316-208-7833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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