Provider Demographics
NPI:1548393283
Name:MOHR, JULIA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:A
Last Name:MOHR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
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?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
68-0-D1-1279-0OtherBLUE CROSS BLUE SHIELD
68-0-D1-1279-0OtherBLUE CROSS BLUE SHIELD