MEDICARE: WILLIAM A. MOSS, PSY.D., LLC

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	103TC0700X	Clinical Psychologist	416	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1629048483	OTHER	SD	NPI NUMBER (OLD)

General Provider Information

NPI Number	:	1033255146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM A. MOSS, PSY.D., LLC

Provider Business Mailing Address
First Line	:	2525 W MAIN ST STE 216
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2439
Country	:	US
Telephone Number	:	605-645-0371
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 W MAIN ST STE 216
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2439
Country	:	US
Telephone Number	:	605-645-0371
Fax Number	:

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	DR. WILLIAM A MOSS
Credential	:	PSY.D.
Telephone Number	:	605-645-0371

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	02/15/2022

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