MEDICARE: JESSICA MOSS

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

General Provider Information

NPI Number	:	1285295691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MOSS

Provider Business Mailing Address
First Line	:	8515 BLUFFTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46809-3022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 HURSH RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-9677
Country	:	US
Telephone Number	:	260-637-3608
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	06/26/2019

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Directions to “ JESSICA MOSS ” Practice Location

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