Active NPI
Donald Patrick Moss, PHD
- Psychologist
- Grand Haven, MI
National Provider Identifier
1124103858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301002566
- Practice address
- 1703 S Despelder
Grand Haven, MI 49417 - Phone
- (616) 842-1277
- Fax
- (616) 842-4190
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301002566 | MI | Primary |
| Clinical Psychologist | 103TC0700X | 6301002566 | MI |
Addresses
Primary practice location
1703 S Despelder
Grand Haven, MI 49417
Mailing address
1703 S Despelder
Grand Haven, MI 49417
Phone (616) 842-1277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301002566 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1124103858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1703 S DESPELDER",
"city": "GRAND HAVEN",
"state": "MI",
"postal_code": "49417",
"telephone_number": "616-842-1277",
"fax_number": "616-842-4190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1703 S DESPELDER",
"city": "GRAND HAVEN",
"state": "MI",
"postal_code": "49417",
"telephone_number": "616-842-1277",
"fax_number": "616-842-4190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "DONALD",
"middle_name": "PATRICK",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301002566",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301002566",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Haven, MI
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- Christopher Michael Mountford, DDS
- Movement Chiropractic Center, PLLC
- Montana Joy Mueller, MSW
- Emile Mulder, PH.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.