Provider Demographics
NPI:1598420820
Name:POPP-MOSS, LORI (MSW, LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:POPP-MOSS
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4124
Mailing Address - Country:US
Mailing Address - Phone:317-259-6822
Mailing Address - Fax:317-259-6823
Practice Address - Street 1:6905 HOOVER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-4124
Practice Address - Country:US
Practice Address - Phone:317-259-6822
Practice Address - Fax:317-259-6823
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000598A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical