Individual
JENNIFER FAY MOSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
233 BASELINE RD, LA VERNE, CA 91750-2353
(909) 593-2581
(909) 596-3567
Mailing address
233 BASELINE RD, LA VERNE, CA 91750-2353
(909) 593-2581
(909) 596-3567
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT34218
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7565A
OUTPATIENT MENTAL HEALTH
CA
Enumeration date
06/20/2012
Last updated
06/20/2012
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