Provider Demographics
NPI:1033275748
Name:MASON MOORE CONSULTANTS
Entity Type:Organization
Organization Name:MASON MOORE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:952-925-5343
Mailing Address - Street 1:5009 EXCELSIOR BLVD STE 136
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3049
Mailing Address - Country:US
Mailing Address - Phone:952-925-5343
Mailing Address - Fax:
Practice Address - Street 1:5009 EXCELSIOR BLVD STE 136
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3049
Practice Address - Country:US
Practice Address - Phone:952-925-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11934MOOtherBCBS GROUP NUMBER
MN6109358OtherMEDICA ID