Provider Demographics
NPI:1649019761
Name:MOSS, CHRISTINA (MA, MFTC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:MA, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9416
Mailing Address - Country:US
Mailing Address - Phone:303-815-9734
Mailing Address - Fax:
Practice Address - Street 1:3652 COLLINS ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-9416
Practice Address - Country:US
Practice Address - Phone:303-815-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist