Provider Demographics
NPI:1346454519
Name:MOSELEY, SUSAN CALLOW (PH D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CALLOW
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 WILLAMETTE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3241
Mailing Address - Country:US
Mailing Address - Phone:541-345-8060
Mailing Address - Fax:541-343-7956
Practice Address - Street 1:3003 WILLAMETTE ST
Practice Address - Street 2:SUITE C
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3241
Practice Address - Country:US
Practice Address - Phone:541-345-8060
Practice Address - Fax:541-343-7956
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR785103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist