Individual
NAN MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, LPC
Contact information
Practice address
1509 N WHITLEY DR STE 11, FRUITLAND, ID 83619-2260
(541) 212-3151
(208) 452-1232
Mailing address
PO BOX 971, ONTARIO, OR 97914-0971
(541) 212-3151
(208) 452-1232
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C1279
OR
101YM0800X
Mental Health Counselor
Primary
LCPC-120
ID
Other
Enumeration date
03/14/2007
Last updated
07/11/2008
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