MEDICARE: MR. ERIC A MOSS CADAC II, MATS

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

General Provider Information

NPI Number	:	1891266821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC A MOSS CADAC II, MATS

Provider Business Mailing Address
First Line	:	2105 N MERIDIAN ST STE 102
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1358
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:	317-926-5498

Provider Business Practice Location Address
First Line	:	2105 N MERIDIAN ST STE 102
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1358
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:	317-926-5498

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	04/01/2019

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