Basic Information
| Provider Information | |||||||||
| NPI: | 1023560299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSENG | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | BS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 16712 HUFFMEISTER RD BLDG 500 | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774298050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817466037 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16712 HUFFMEISTER RD BLDG 500 | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774298050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817466037 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2016 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-17-27874 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.