Provider Demographics
NPI:1639951775
Name:MOSLEY, SHYESA VONQUASJA (RBT)
Entity Type:Individual
Prefix:
First Name:SHYESA
Middle Name:VONQUASJA
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 KENT ST APT 124
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2724
Mailing Address - Country:US
Mailing Address - Phone:979-314-0544
Mailing Address - Fax:
Practice Address - Street 1:555 WILLIAM D FITCH PKWY
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6141
Practice Address - Country:US
Practice Address - Phone:979-314-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-296846106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician