Provider Demographics
NPI:1497306187
Name:MOSELEY, DEIDRE (MS, MS)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:MS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 PATRICIA AVE APT 157
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0429
Mailing Address - Country:US
Mailing Address - Phone:661-433-6716
Mailing Address - Fax:
Practice Address - Street 1:25134 RYE CANYON LOOP STE 270
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-5030
Practice Address - Country:US
Practice Address - Phone:661-843-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst