Doctor Name: | AMBER BRISA MOSS |
NPI Number: | 1003244971 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RMHCI |
License Number: | IMH11197 |
Business Practice Address: | 922 Sw Baya Dr Lake City, FL - 320254209 |
Business Phone Number: | 3867549005 |
Business Fax Number: | 3867549017 |
Mailing Address: | 20251 E Levy St, WILLISTON |
State: | FL |
Postal Code: | 326967375 |
Phone Number: | 5082545807 |
Fax Number: | |
NPI Enumeration Date: | 10/31/2013 |
NPI Last Update Date: | 10/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMH11197 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |