| Doctor Name: | MR. WENDELL DEMARR MOSS |
| NPI Number: | 1033590955 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. |
| License Number: | LH60473731 |
| Business Practice Address: | 1622 3rd St Marysville, WA - 982705004 |
| Business Phone Number: | 4252246693 |
| Business Fax Number: | |
| Mailing Address: | 2231 Rucker Ave Apt 9, EVERETT |
| State: | WA |
| Postal Code: | 982012783 |
| Phone Number: | 4252246693 |
| Fax Number: | |
| NPI Enumeration Date: | 06/16/2015 |
| NPI Last Update Date: | 06/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LH60473731 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |