Provider Demographics
NPI:1992161269
Name:MOSLEY, TAMARA (LPC)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAKE CAROLYN PKWY APT 4208
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3935
Mailing Address - Country:US
Mailing Address - Phone:254-291-9091
Mailing Address - Fax:
Practice Address - Street 1:1000 LAKE CAROLYN PKWY APT 4208
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3935
Practice Address - Country:US
Practice Address - Phone:254-291-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-02
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health