Provider Demographics
NPI:1346490075
Name:HORNETT-MOSS, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:HORNETT-MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-1267
Mailing Address - Country:US
Mailing Address - Phone:530-625-4236
Mailing Address - Fax:530-625-4258
Practice Address - Street 1:2 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546-1267
Practice Address - Country:US
Practice Address - Phone:530-625-4236
Practice Address - Fax:530-625-4258
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM13986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist