Provider Demographics
NPI:1013006113
Name:MOSELEY, SALLY K (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:K
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W. MARSHALL AVE.
Mailing Address - Street 2:SUITE 430
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604
Mailing Address - Country:US
Mailing Address - Phone:903-297-4592
Mailing Address - Fax:903-297-4689
Practice Address - Street 1:3400 W. MARSHALL AVE.
Practice Address - Street 2:SUITE 430
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604
Practice Address - Country:US
Practice Address - Phone:903-297-4592
Practice Address - Fax:903-297-4689
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional