MEDICARE: JUDITH LYNNE 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	101YP2500X	Professional Counselor	002772	MO

General Provider Information

NPI Number	:	1356533053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH LYNNE MOSS LPC

Provider Business Mailing Address
First Line	:	2725 NORTH WESTWOOD BLVD. SUITE 8
Second Line	:	LIVING BETTER BEHAVIORAL HEALTH, LLC
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901
Country	:	US
Telephone Number	:	573-785-5224
Fax Number	:	573-776-1464

Provider Business Practice Location Address
First Line	:	2725 N WESTWOOD BLVD STE 8
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2367
Country	:	US
Telephone Number	:	573-785-5224
Fax Number	:	573-776-1464

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	03/13/2015

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