Provider Demographics
NPI:1609088301
Name:SALLY K. MOSELEY, LPC, P.A.
Entity Type:Organization
Organization Name:SALLY K. MOSELEY, LPC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-297-4592
Mailing Address - Street 1:1800 W LOOP 281
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2568
Mailing Address - Country:US
Mailing Address - Phone:903-297-4592
Mailing Address - Fax:
Practice Address - Street 1:1800 W LOOP 281
Practice Address - Street 2:SUITE 207
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2568
Practice Address - Country:US
Practice Address - Phone:903-297-4592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013006113OtherNPI INDIVIDUAL
TX028712001Medicaid
TX19GTOtherBLUE CROSS BLUE SHIELD
TX84049LOtherBLUE CROSS BLUE SHIELD