Provider Demographics
NPI:1518106129
Name:MOSS, WILLIAM H JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:H
Last Name:MOSS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 N.W. BROADWAY ST.
Mailing Address - Street 2:STE. #202
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-317-8797
Mailing Address - Fax:
Practice Address - Street 1:754 NW BROADWAY ST STE 202
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2776
Practice Address - Country:US
Practice Address - Phone:541-317-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL3257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health