Provider Demographics
NPI:1578826434
Name:MOSS, MATTHEW WAYNE (RAS, CAADD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WAYNE
Last Name:MOSS
Suffix:
Gender:M
Credentials:RAS, CAADD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 S H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-5602
Mailing Address - Country:US
Mailing Address - Phone:661-398-4303
Mailing Address - Fax:
Practice Address - Street 1:2901 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-5602
Practice Address - Country:US
Practice Address - Phone:661-398-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM1007210958101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)