Provider Demographics
NPI:1568823946
Name:MOSES, MAMIE LYNN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MAMIE
Middle Name:LYNN
Last Name:MOSES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 CAROLYN SUE DR
Mailing Address - Street 2:SUITE 773
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5509
Mailing Address - Country:US
Mailing Address - Phone:225-928-9398
Mailing Address - Fax:225-928-9490
Practice Address - Street 1:1933 CAROLYN SUE DR
Practice Address - Street 2:SUITE 773
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5509
Practice Address - Country:US
Practice Address - Phone:225-928-9398
Practice Address - Fax:225-928-9490
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5774101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional