Active NPI
Elizabeth Diane Moussas, PH.D.
- Health Psychologist
- Wilder, KY
National Provider Identifier
1376749762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- License
- 3942
- Practice address
- 69 Sentry Dr
Wilder, KY 41076-1465 - Phone
- (859) 442-7338
- NPI assigned
- Jun 22, 2007
- Last updated
- Sep 11, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3942 | OH | |
| Clinical Psychologist | 103TC0700X | 3942 | OH | |
| Health Psychologist | 103TH0004X | 3942 | OH | Primary |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 3942 | OH |
Addresses
Primary practice location
69 Sentry Dr
Wilder, KY 41076-1465
Mailing address
69 Sentry Dr
Wilder, KY 41076-1465
Phone (859) 442-7338
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0687225 | Medicaid | OH |
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3942 | OH | MD | Chiropractor |
Interoperability endpoints
- elizabeth.moussas.1@31830.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1376749762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "69 SENTRY DR",
"city": "WILDER",
"state": "KY",
"postal_code": "410761465",
"telephone_number": "859-442-7338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "69 SENTRY DR",
"city": "WILDER",
"state": "KY",
"postal_code": "410761465",
"telephone_number": "859-442-7338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUSSAS",
"first_name": "ELIZABETH",
"middle_name": "DIANE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-22",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "3942",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "3942",
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "OH",
"license": "3942",
"primary": true
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "OH",
"license": "3942",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0687225",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilder, KY
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.