MEDICARE: SEASONS TREATMENT, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1297	WV
2	101YM0800X	Mental Health Counselor	1297	WV
3	101YP2500X	Professional Counselor	1297	WV

General Provider Information

NPI Number	:	1578064580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASONS TREATMENT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 648
Second Line	:
City	:	MADISON
State	:	WV
Zip	:	25130-0648
Country	:	US
Telephone Number	:	304-745-7837
Fax Number	:	360-242-5842

Provider Business Practice Location Address
First Line	:	2162 CHILDRESS RD
Second Line	:
City	:	ALUM CREEK
State	:	WV
Zip	:	25003-9546
Country	:	US
Telephone Number	:	304-745-7837
Fax Number	:	360-242-5842

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES BRIAN MOSLEY
Credential	:	LPC
Telephone Number	:	304-989-3946

Provider Enumeration Date	:	02/24/2018
Last Update Date	:	02/24/2018

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