# RIDGELINE PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356959951
- **Authorized official:** CARLY MOSS LPC (OWNER)
- **Authorized official phone:** (423) 802-8414

## Contact information

- **Practice address:** 4625 N BROADWAY, SUITE 105, TUCSON, AZ 85711
- **Practice address phone:** (423) 802-8414
- **Mailing address:** 7712 N RED WING PL, TUCSON, AZ 85741-1331
- **Mailing address phone:** (423) 802-8414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 07/20/2020
- **Last updated:** 07/20/2020