Provider Demographics
NPI:1508999277
Name:DR. JULIA A. MOHR, PLC
Entity Type:Organization
Organization Name:DR. JULIA A. MOHR, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-956-9565
Mailing Address - Street 1:967 SPAULDING AVE SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-3700
Mailing Address - Country:US
Mailing Address - Phone:616-956-9565
Mailing Address - Fax:
Practice Address - Street 1:967 SPAULDING AVE SE
Practice Address - Street 2:SUITE E
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-3700
Practice Address - Country:US
Practice Address - Phone:616-956-9565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010680103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
68-0-D1-1279-0OtherBLUE CROSS BLUE SHIELD
ON90340Medicare PIN