| Doctor Name: | NAN MOSS |
| NPI Number: | 1215060538 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC, LPC |
| License Number: | C1279 |
| Business Practice Address: | 1509 N Whitley Dr Ste 11 Fruitland, ID - 836192260 |
| Business Phone Number: | 5412123151 |
| Business Fax Number: | 2084521232 |
| Mailing Address: | Po Box 971, ONTARIO |
| State: | OR |
| Postal Code: | 979140971 |
| Phone Number: | 5412123151 |
| Fax Number: | 2084521232 |
| NPI Enumeration Date: | 03/14/2007 |
| NPI Last Update Date: | 07/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C1279 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |