Provider Demographics
NPI:1932965472
Name:MOSES, LEANN MARIE
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:MARIE
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:MARIE
Other - Last Name:ANDING, HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:803 S RUSK ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-6648
Mailing Address - Country:US
Mailing Address - Phone:806-374-6688
Mailing Address - Fax:
Practice Address - Street 1:803 S RUSK ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6648
Practice Address - Country:US
Practice Address - Phone:806-374-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66764101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)