MEDICARE: TRACEE MOSS

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	E.0004017-SUPV	OH

General Provider Information

NPI Number	:	1588174304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRACEE MOSS

Provider Business Mailing Address
First Line	:	3050 SOUTHWIND TRL
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-2880
Country	:	US
Telephone Number	:	330-953-1202
Fax Number	:	330-953-1204

Provider Business Practice Location Address
First Line	:	3050 SOUTHWIND TRL
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-2880
Country	:	US
Telephone Number	:	330-953-1202
Fax Number	:	330-953-1204

Authorized Official
Title or Position	:	OWNER
Name	:	TRACEE MOSS
Credential	:
Telephone Number	:	330-953-1202

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	07/02/2024

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