Provider Demographics
NPI:1912641622
Name:MOSE, SHAMETRISS (RBT)
Entity Type:Individual
Prefix:
First Name:SHAMETRISS
Middle Name:
Last Name:MOSE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 LITTLE CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1715
Mailing Address - Country:US
Mailing Address - Phone:832-412-6307
Mailing Address - Fax:
Practice Address - Street 1:2170 LITTLE CEDAR DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1715
Practice Address - Country:US
Practice Address - Phone:832-412-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician