Most Relevant Information
Provider Data
| NPI Number: | 1003244971 |
| Provider Name: | AMBER BRISA MOSS RMHCI |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | IMH11197 |
Most Important Dates
| Enumeration Date: | 10/31/2013 |
| Last Updated: | 10/31/2013 |
Provider Practice Location
922 SW BAYA DR
LAKE CITY
FL
320254209
Practice Location Phone/Fax
| Phone: | 3867549005 |
| Fax: | 3867549017 |
Provider Mailing Location
20251 E LEVY ST
WILLISTON
FL
326967375
Provider Mailing Phone/Fax
| Phone: | 5082545807 |
| Fax: |