Provider Demographics
NPI:1710920905
Name:MOLSTRE, JOHN A (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MOLSTRE
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 1:3928 RIVER OAK CIR
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 32ND AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5001
Practice Address - Country:US
Practice Address - Phone:218-233-7524
Practice Address - Fax:218-233-8627
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1010547OtherPREFERREDONE
FM61-20239OtherUNITED BEHAVIORAL HEALTH
MNHP23079OtherHEALTHPARTNERS
MN116464OtherUCARE MINNESOTA
NC5379OtherNORTH DAKOTA BLUE SHIELD
MN57413MOOtherBLLUE SHIELD OF MINNESOTA