MEDICARE: MOSSY STONE COUNSELING & WELLNESS, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1396489092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSSY STONE COUNSELING & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	70 STEVENS DR
Second Line	:
City	:	HOLBROOK
State	:	MA
Zip	:	02343-1239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 STEVENS DR
Second Line	:
City	:	HOLBROOK
State	:	MA
Zip	:	02343-1239
Country	:	US
Telephone Number	:	310-663-4607
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LMHC
Name	:	SARINA FRANCESCA VAN ZYL
Credential	:
Telephone Number	:	310-663-4607

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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