| Doctor Name: | KIMBERLY MOOS |
| NPI Number: | 1134567035 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC |
| License Number: | 303060 |
| Business Practice Address: | 1326 E Ripley St Litchfield, MN - 553554525 |
| Business Phone Number: | 3205930440 |
| Business Fax Number: | 3205930442 |
| Mailing Address: | 1326 E Ripley St, LITCHFIELD |
| State: | MN |
| Postal Code: | 553554525 |
| Phone Number: | 3205930440 |
| Fax Number: | 3205930442 |
| NPI Enumeration Date: | 06/13/2013 |
| NPI Last Update Date: | 06/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 303060 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |