MEDICARE: DR. WILLIAM A. MOSS PSY.D.

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	103TC0700X	Clinical Psychologist	416	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629048483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM A. MOSS PSY.D.

Provider Business Mailing Address
First Line	:	403 NATIONAL ST
Second Line	:	STE 1
City	:	RAPID CITY
State	:	SD
Zip	:	57702-5908
Country	:	US
Telephone Number	:	605-341-8647
Fax Number	:	605-341-0489

Provider Business Practice Location Address
First Line	:	3601 CANYON LAKE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3305
Country	:	US
Telephone Number	:	605-341-8647
Fax Number	:	605-341-0489

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	10/07/2019

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