Provider Demographics
NPI:1184641730
Name:MOSS, TRACEE (MS IN ED)
Entity Type:Individual
Prefix:MS
First Name:TRACEE
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:MS IN ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 SOUTHWIND TRL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2880
Mailing Address - Country:US
Mailing Address - Phone:330-953-1202
Mailing Address - Fax:330-953-1204
Practice Address - Street 1:3050 SOUTHWIND TRL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-2880
Practice Address - Country:US
Practice Address - Phone:330-953-1202
Practice Address - Fax:330-953-1204
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0004017101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH24875600OtherMIS # MAGELLAN HEALTH SER