Individual
BETHANY A MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1412 MAIN ST STE 613, DALLAS, TX 75202-4125
(214) 542-5642
Mailing address
1412 MAIN ST STE 613, DALLAS, TX 75202-4125
(214) 542-5642
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
73916
TX
Other
Enumeration date
06/27/2017
Last updated
06/27/2017
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