Provider Demographics
NPI:1376632265
Name:MOSLEY, MARTHA L (LMFT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NIAGARA AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4128
Mailing Address - Country:US
Mailing Address - Phone:920-451-8667
Mailing Address - Fax:920-451-8799
Practice Address - Street 1:314 NIAGARA AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4128
Practice Address - Country:US
Practice Address - Phone:920-451-8667
Practice Address - Fax:920-451-8799
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI744-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist