Provider Demographics
NPI:1265291587
Name:MOSS, OLLIE CAR'NNE (MA, LBS)
Entity type:Individual
Prefix:
First Name:OLLIE
Middle Name:CAR'NNE
Last Name:MOSS
Suffix:
Gender:F
Credentials:MA, LBS
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:ANNE
Other - Last Name:MOTL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:463A BUTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HELLAM
Mailing Address - State:PA
Mailing Address - Zip Code:17406-9060
Mailing Address - Country:US
Mailing Address - Phone:325-455-4277
Mailing Address - Fax:
Practice Address - Street 1:1407 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9000
Practice Address - Country:US
Practice Address - Phone:717-894-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007008103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst