Provider Demographics
NPI:1407339567
Name:MOSS, BETSY (LIMHP, LIMFT, LMFT)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:LIMHP, LIMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12035 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3542
Mailing Address - Country:US
Mailing Address - Phone:402-991-0611
Mailing Address - Fax:402-991-6228
Practice Address - Street 1:12035 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3542
Practice Address - Country:US
Practice Address - Phone:402-991-0611
Practice Address - Fax:402-991-6228
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121548101YM0800X
NE206101YM0800X
NE2442101YM0800X
NE2264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health