Provider Demographics
NPI:1801269386
Name:MOSES, TAILAR B
Entity type:Individual
Prefix:
First Name:TAILAR
Middle Name:B
Last Name:MOSES
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 1:2001 OAK CREEK RD APT C122
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5841
Mailing Address - Country:US
Mailing Address - Phone:504-609-9014
Mailing Address - Fax:
Practice Address - Street 1:1202 MONROE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-2307
Practice Address - Country:US
Practice Address - Phone:844-864-7834
Practice Address - Fax:844-864-7834
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 174400000X
LAPLC9195101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist