Provider Demographics
NPI:1558566067
Name:HAROLD P MOSELEY DBA LIFE ENRICHMENT SERVICES
Entity Type:Organization
Organization Name:HAROLD P MOSELEY DBA LIFE ENRICHMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:402-740-6576
Mailing Address - Street 1:4780 S 131ST ST
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1865
Mailing Address - Country:US
Mailing Address - Phone:402-740-6576
Mailing Address - Fax:402-504-3111
Practice Address - Street 1:4780 S 131ST ST
Practice Address - Street 2:SUITE 7A
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1865
Practice Address - Country:US
Practice Address - Phone:402-740-6576
Practice Address - Fax:402-504-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP #914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82425OtherBLUE CROSS/BLUE SHIELD FOR HAROLD MOSELEY, LCSW
NE85529OtherBLUECROSS/BLUE SHIELD FOR SHARON G. MOSELEY, LCSW
NE10025477100Medicaid
NE=========26Medicaid