Provider Demographics
NPI:1841475183
Name:MOOS, REBECCA MELERINE
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MELERINE
Last Name:MOOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9579 HOYLE BEALS DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4239
Mailing Address - Country:US
Mailing Address - Phone:303-815-6559
Mailing Address - Fax:
Practice Address - Street 1:9579 HOYLE BEALS DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-4239
Practice Address - Country:US
Practice Address - Phone:303-815-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7964101YM0800X, 101YP2500X
LA5213101YM0800X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health