MEDICARE: ALEXANDRIA MOSS AMFT

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	138718	CA

General Provider Information

NPI Number	:	1487412300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA MOSS AMFT

Provider Business Mailing Address
First Line	:	1024 EVERGLADES DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-5637
Country	:	US
Telephone Number	:	214-250-6865
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 VINE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5250
Country	:	US
Telephone Number	:	213-584-4445
Fax Number	:

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

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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