| Marissa Renee Moss, | |
|
30 N Sherman St Apt 12, Denver, CO 80203-4819 | |
| (631) 741-6102 | |
| Not Available |
| Full Name | Marissa Renee Moss |
|---|---|
| Gender | Female |
| Speciality | Counselor - Mental Health |
| Location | 30 N Sherman St Apt 12, Denver, Colorado |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295317782 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LPC.0021034 (Colorado) | Primary |
| Entity Name | Sondermind Provider Network Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760854442 PECOS PAC ID: 9537572490 Enrollment ID: O20210113002826 |
| Mailing Address | Practice Location Address |
|---|---|
| Marissa Renee Moss, 30 N Sherman St Apt 12, Denver, CO 80203-4819 Ph: (631) 741-6102 | Marissa Renee Moss, 30 N Sherman St Apt 12, Denver, CO 80203-4819 Ph: (631) 741-6102 |
Ms. Leilani Tomo Blashill, M.A. Counselor Medicare: Not Enrolled in Medicare Practice Location: 456 Bannock St., Denver, CO 80204 Phone: 303-504-1700 Fax: 303-733-8239 | |
Ziphora Chaim, Counselor Medicare: Not Enrolled in Medicare Practice Location: 900 S Broadway, Suite 100, Denver, CO 80209 Phone: 303-603-3020 | |
Keith Reid Kendall, Counselor Medicare: Not Enrolled in Medicare Practice Location: 900 S Broadway, Ste 100, Denver, CO 80209 Phone: 303-603-3020 | |
Ronald J Meyer, LPC Counselor Medicare: Medicare Enrolled Practice Location: 2130 Stout St, Denver, CO 80205 Phone: 303-312-9601 | |
Dwayne K Harris, CAC III Counselor Medicare: Not Enrolled in Medicare Practice Location: 1155 Cherokee St, Denver, CO 80204 Phone: 303-436-6000 | |
Amber L Surls, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 8190 E 1st Ave, Suite 105, Denver, CO 80230 Phone: 303-731-8900 Fax: 303-367-7910 | |
Mrs. Lucia Divieste-severtson, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1740 Marion St, Denver, CO 80218 Phone: 720-412-7858 |