Provider Demographics
NPI:1063558542
Name:MOSSE, LEAH KATHRYN (LPC)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:KATHRYN
Last Name:MOSSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:HAWKINS
Mailing Address - State:TX
Mailing Address - Zip Code:75765-0333
Mailing Address - Country:US
Mailing Address - Phone:877-495-7665
Mailing Address - Fax:877-495-7665
Practice Address - Street 1:145 BEAULAH
Practice Address - Street 2:
Practice Address - City:HAWKINS
Practice Address - State:TX
Practice Address - Zip Code:75765
Practice Address - Country:US
Practice Address - Phone:877-495-7665
Practice Address - Fax:877-495-7665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13870101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007161316OtherAETNA
TX271155OtherMAGELLAN
TX0001046152OtherMHN
TX1223630OtherCIGNA
TX00004124LCOtherBLUE CROSS