Provider Demographics
NPI:1154855831
Name:MOSHER PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MOSHER PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-720-5006
Mailing Address - Street 1:812 E 48TH ST
Mailing Address - Street 2:#6
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:812 E 48TH ST
Practice Address - Street 2:#6
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1066
Practice Address - Country:US
Practice Address - Phone:518-720-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty