Provider Demographics
NPI:1154740371
Name:MOSELEY, KERA (DRPH, LAC, CCS)
Entity type:Individual
Prefix:DR
First Name:KERA
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:DRPH, LAC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13287 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-4599
Mailing Address - Country:US
Mailing Address - Phone:985-839-6900
Mailing Address - Fax:985-839-6900
Practice Address - Street 1:13287 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-4599
Practice Address - Country:US
Practice Address - Phone:985-839-6900
Practice Address - Fax:985-839-6900
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)