Provider Demographics
NPI:1639910102
Name:MOSLEY, TIARA MONIQUE (LMSW)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:MONIQUE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 SAXON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-3842
Mailing Address - Country:US
Mailing Address - Phone:319-550-2567
Mailing Address - Fax:
Practice Address - Street 1:307 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5796
Practice Address - Country:US
Practice Address - Phone:641-323-2729
Practice Address - Fax:888-920-1276
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker