Provider Demographics
NPI:1295317782
Name:MOSS, MARISSA RENEE
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:RENEE
Last Name:MOSS
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 1:30 N SHERMAN ST APT 12
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4819
Mailing Address - Country:US
Mailing Address - Phone:631-741-6102
Mailing Address - Fax:
Practice Address - Street 1:30 N SHERMAN ST APT 12
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4819
Practice Address - Country:US
Practice Address - Phone:631-741-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0021034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health