Provider Demographics
NPI:1457546087
Name:MOSS, LAURIE RUTH (MA LMHC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:RUTH
Last Name:MOSS
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 QUEEN ANNE AVENUE NORTH
Mailing Address - Street 2:SUITE #204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:206-283-3374
Mailing Address - Fax:
Practice Address - Street 1:1811 QUEEN ANNE AVENUE NORTH
Practice Address - Street 2:SUITE #204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109
Practice Address - Country:US
Practice Address - Phone:206-283-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health