Provider Demographics
NPI:1508172396
Name:MOSS, ANTHONY ALLEN
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALLEN
Last Name:MOSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 GINA LN
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-1113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 GINA LN
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:OK
Practice Address - Zip Code:74016-1113
Practice Address - Country:US
Practice Address - Phone:918-519-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor