Provider Demographics
NPI:1952936601
Name:MOSER, KEVIN T (LMHC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:MOSER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 N 9TH AVE STE B5
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7378
Mailing Address - Country:US
Mailing Address - Phone:850-512-0386
Mailing Address - Fax:
Practice Address - Street 1:6706 N 9TH AVE STE B5
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7378
Practice Address - Country:US
Practice Address - Phone:850-512-0386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health