Provider Demographics
NPI:1023479789
Name:MOSS, KRYSTIE
Entity type:Individual
Prefix:MRS
First Name:KRYSTIE
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRYSTIE
Other - Middle Name:
Other - Last Name:BIRKHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:741 TIMBERWILDE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6308
Mailing Address - Country:US
Mailing Address - Phone:540-850-9978
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGHWAY 27 STE 4
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2411
Practice Address - Country:US
Practice Address - Phone:352-708-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health