Provider Demographics
NPI:1033255146
Name:WILLIAM A. MOSS, PSY.D., LLC
Entity Type:Organization
Organization Name:WILLIAM A. MOSS, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:605-645-0371
Mailing Address - Street 1:2525 W MAIN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2439
Mailing Address - Country:US
Mailing Address - Phone:605-645-0371
Mailing Address - Fax:
Practice Address - Street 1:2525 W MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2439
Practice Address - Country:US
Practice Address - Phone:605-645-0371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6551862Medicaid
SD1629048483OtherNPI NUMBER (OLD)
SD6551862Medicaid