Individual
MARQUE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
149 S ANDOVER RD STE 100, ANDOVER, KS 67002-7935
(719) 349-0472
Mailing address
412 N HOWARD ST, PRATT, KS 67124-1932
(719) 349-0472
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
10200
KS
1041C0700X
Clinical Social Worker
Primary
5211
KS
Other
Enumeration date
08/02/2013
Last updated
06/30/2021
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