Provider Demographics
NPI:1033457817
Name:MOSS, FELICIA L (LPC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:L
Last Name:MOSS
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 1:4002 BURKE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3451
Mailing Address - Country:US
Mailing Address - Phone:832-345-1700
Mailing Address - Fax:832-345-1760
Practice Address - Street 1:4002 BURKE RD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3451
Practice Address - Country:US
Practice Address - Phone:832-345-1700
Practice Address - Fax:832-345-1760
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012041492101YP2500X
TX77794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1033457817Medicaid