MEDICARE: MARY MOSELEY LPC-S

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	67005	TX

General Provider Information

NPI Number	:	1417302415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MOSELEY LPC-S

Provider Business Mailing Address
First Line	:	11933 LUCKEY FLS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78252-2320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11153 WESTWOOD LOOP STE 118
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6766
Country	:	US
Telephone Number	:	726-842-0498
Fax Number	:

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

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	04/05/2024

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Directions to “ MARY MOSELEY LPC-S” Practice Location

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