Provider Demographics
NPI:1053758565
Name:MOSS, GEORGE GILBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GILBERT
Last Name:MOSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:NOTRE DAME
Mailing Address - State:IN
Mailing Address - Zip Code:46556-0084
Mailing Address - Country:US
Mailing Address - Phone:574-514-4302
Mailing Address - Fax:
Practice Address - Street 1:22057 SANDYBROOK DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9651
Practice Address - Country:US
Practice Address - Phone:574-514-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling