Provider Demographics
NPI:1689269110
Name:MOSLEY, KIMBERLY (LSSP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N AKARD ST APT 1101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3454
Mailing Address - Country:US
Mailing Address - Phone:469-588-0488
Mailing Address - Fax:
Practice Address - Street 1:300 N AKARD ST APT 1101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3454
Practice Address - Country:US
Practice Address - Phone:773-956-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty