Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103TC1900X | Counseling Psychologist |
NPI | 1134586654 |
---|---|
Provider Name | Dr. Randy K Moss |
First Address | Mountain Green, UT 84050-5515 |
Second Address | Kaysville, UT 84037-4203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2016 |
Last Update Date | 28/01/2016 |