Provider Demographics
NPI:1598552960
Name:MOSS, SHELLY OSBORN
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:OSBORN
Last Name:MOSS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:VIRGINIA
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 RIO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-6406
Mailing Address - Country:US
Mailing Address - Phone:806-335-5749
Mailing Address - Fax:
Practice Address - Street 1:100 RIO VISTA DR
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-6406
Practice Address - Country:US
Practice Address - Phone:806-335-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX269971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical