Organization
RIDGELINE PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLY MOSS LPC (OWNER)
(423) 802-8414
Entity
Organization
Contact information
Practice address
4625 N BROADWAY, SUITE 105, TUCSON, AZ 85711
(423) 802-8414
Mailing address
7712 N RED WING PL, TUCSON, AZ 85741-1331
(423) 802-8414
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/20/2020
Last updated
07/20/2020
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