Provider Demographics
NPI:1487025276
Name:MOSES, JUANICE
Entity Type:Individual
Prefix:
First Name:JUANICE
Middle Name:
Last Name:MOSES
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 1:8017 CARDIGAN WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-4902
Mailing Address - Country:US
Mailing Address - Phone:318-332-2542
Mailing Address - Fax:318-332-2542
Practice Address - Street 1:8017 CARDIGAN WAY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-4902
Practice Address - Country:US
Practice Address - Phone:318-332-2542
Practice Address - Fax:318-332-2542
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor