MEDICARE: RYAN MOSELEY PLMHP

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	10232	NE

General Provider Information

NPI Number	:	1891107355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MOSELEY PLMHP

Provider Business Mailing Address
First Line	:	2311 N 152ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-7175
Country	:	US
Telephone Number	:	402-680-0548
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 S 96TH ST
Second Line	:	SUITE 111
City	:	OMAHA
State	:	NE
Zip	:	68127-1202
Country	:	US
Telephone Number	:	402-680-0548
Fax Number	:

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

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/02/2014

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Directions to “ RYAN MOSELEY PLMHP” Practice Location

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