Provider Demographics
NPI:1952664021
Name:MOSLEY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:MOSLEY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAMAR
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:COUNSELOR
Authorized Official - Phone:909-252-3183
Mailing Address - Street 1:2130 N. ARROWHEAD AVE
Mailing Address - Street 2:SUITE 103C
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405
Mailing Address - Country:US
Mailing Address - Phone:909-723-8290
Mailing Address - Fax:909-723-8290
Practice Address - Street 1:2130 W. ARROWHEAD AVE.
Practice Address - Street 2:SUITE 103C
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405
Practice Address - Country:US
Practice Address - Phone:909-723-8290
Practice Address - Fax:909-723-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAVIC2-790-081513B101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty