Provider Demographics
NPI:1891107355
Name:MOSELEY, RYAN (PLMHP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 N 152ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-7175
Mailing Address - Country:US
Mailing Address - Phone:402-680-0548
Mailing Address - Fax:
Practice Address - Street 1:4611 S 96TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1202
Practice Address - Country:US
Practice Address - Phone:402-680-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health