MEDICARE: JEREMY MOSS MA

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	LH60108045	WA
2	101YM0800X	Mental Health Counselor	006385	NY

General Provider Information

NPI Number	:	1750568325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY MOSS MA

Provider Business Mailing Address
First Line	:	1122 E PIKE ST
Second Line	:	#814
City	:	SEATTLE
State	:	WA
Zip	:	98122-3916
Country	:	US
Telephone Number	:	206-271-9376
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N 36TH ST
Second Line	:	#214
City	:	SEATTLE
State	:	WA
Zip	:	98103-8697
Country	:	US
Telephone Number	:	206-271-9376
Fax Number	:

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

Provider Enumeration Date	:	01/26/2008
Last Update Date	:	01/16/2017

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Directions to “ JEREMY MOSS MA” Practice Location

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