Provider Demographics
NPI:1275768202
Name:MOSS, JAVANA J (LPC)
Entity Type:Individual
Prefix:
First Name:JAVANA
Middle Name:J
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 1:290 COUNTRY RIDGE RD UNIT 11
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4549
Mailing Address - Country:US
Mailing Address - Phone:501-240-6538
Mailing Address - Fax:
Practice Address - Street 1:105 KATHRYN DR BLDG 3
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4216
Practice Address - Country:US
Practice Address - Phone:800-972-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334793201Medicaid
TX847LPLOtherBLUC CROSS BLUE SHIELD
TX334793202OtherMEDICAID CSHCN