Provider Demographics
NPI:1689707952
Name:MOSEME, MOTSELISI
Entity Type:Individual
Prefix:
First Name:MOTSELISI
Middle Name:
Last Name:MOSEME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 LYNDON LN
Mailing Address - Street 2:STE 6
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4643
Mailing Address - Country:US
Mailing Address - Phone:502-851-8831
Mailing Address - Fax:502-326-8970
Practice Address - Street 1:714 LYNDON LN
Practice Address - Street 2:6
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4643
Practice Address - Country:US
Practice Address - Phone:502-851-8831
Practice Address - Fax:502-326-8970
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100282460Medicaid
KY16896707952OtherNATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM