Provider Demographics
NPI:1285722850
Name:MOSS, BARRY FRANKLIN (PHD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:FRANKLIN
Last Name:MOSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 196TH ST SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6152
Mailing Address - Country:US
Mailing Address - Phone:425-778-4174
Mailing Address - Fax:425-775-8416
Practice Address - Street 1:5108 196TH ST SW
Practice Address - Street 2:SUITE 102
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6152
Practice Address - Country:US
Practice Address - Phone:425-778-4174
Practice Address - Fax:425-775-8416
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001658103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7055270Medicaid