Provider Demographics
NPI:1134284334
Name:MOSHER, DANIEL G (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:MOSHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3887 OKEMOS RD
Mailing Address - Street 2:STE.A2
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3664
Mailing Address - Country:US
Mailing Address - Phone:517-349-4655
Mailing Address - Fax:517-347-3702
Practice Address - Street 1:3887 OKEMOS RD
Practice Address - Street 2:STE.A2
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3664
Practice Address - Country:US
Practice Address - Phone:517-349-4655
Practice Address - Fax:517-347-3702
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006546103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C346660OtherBCBSM
MI0C34666Medicare ID - Type Unspecified