Provider Demographics
NPI:1679247464
Name:MOSS, CARLY MCKENNA (LMFTA)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:MCKENNA
Last Name:MOSS
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 HWY 70 S STE 137
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2207
Mailing Address - Country:US
Mailing Address - Phone:615-933-1646
Mailing Address - Fax:
Practice Address - Street 1:7051 HWY 70 S STE 137
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2207
Practice Address - Country:US
Practice Address - Phone:615-933-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty