Provider Demographics
NPI:1073838298
Name:MOSLEY, KRISTINA LOUISE (M ED BCBA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LOUISE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:M ED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 12TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5804
Mailing Address - Country:US
Mailing Address - Phone:120-660-4401
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST
Practice Address - Street 2:SUITE 505
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7264
Practice Address - Country:US
Practice Address - Phone:253-671-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-09-6400103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst