| Doctor Name: | DR. RANDY K MOSS |
| NPI Number: | 1134586654 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | |
| Business Practice Address: | 447 N 300 W Kaysville, UT - 840374203 |
| Business Phone Number: | 9072325374 |
| Business Fax Number: | 8015443819 |
| Mailing Address: | 4589 Ranch Blvd, MOUNTAIN GREEN |
| State: | UT |
| Postal Code: | 840505515 |
| Phone Number: | 9072325374 |
| Fax Number: | 8015443819 |
| NPI Enumeration Date: | 01/28/2016 |
| NPI Last Update Date: | 01/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |