Provider Demographics
NPI:1760013445
Name:MOSS, LYNNELL (MA)
Entity Type:Individual
Prefix:
First Name:LYNNELL
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 ODESSA CIR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3830
Mailing Address - Country:US
Mailing Address - Phone:631-942-9150
Mailing Address - Fax:
Practice Address - Street 1:1985 ODESSA CIR
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-3830
Practice Address - Country:US
Practice Address - Phone:631-942-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty