Provider Demographics
NPI:1407915200
Name:MOSELEY, HAROLD PRENTICE (MSW, LCSW, IMHP)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:PRENTICE
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:MSW, LCSW, IMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34280
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0280
Mailing Address - Country:US
Mailing Address - Phone:402-740-6576
Mailing Address - Fax:
Practice Address - Street 1:6107 MAPLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-4001
Practice Address - Country:US
Practice Address - Phone:402-740-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEIMHP #878101YM0800X
NE831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85362OtherBLUE CROSS BLUE SHIELD