Provider Demographics
NPI:1144752189
Name:RYAN MOSELEY
Entity Type:Organization
Organization Name:RYAN MOSELEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROP
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-680-0548
Mailing Address - Street 1:1918 N 151ST PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1062
Mailing Address - Country:US
Mailing Address - Phone:402-680-0548
Mailing Address - Fax:
Practice Address - Street 1:11907 ARBOR ST
Practice Address - Street 2:STE E
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3002
Practice Address - Country:US
Practice Address - Phone:402-680-0548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10232251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health