Provider Demographics
NPI:1891260535
Name:MOSLING, JUSTIN (MS LPC CSAC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MOSLING
Suffix:
Gender:M
Credentials:MS LPC CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N52W14104 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6828
Mailing Address - Country:US
Mailing Address - Phone:608-397-4353
Mailing Address - Fax:
Practice Address - Street 1:13000 W BLUEMOUND RD # 300
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2650
Practice Address - Country:US
Practice Address - Phone:262-785-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5566-125101YP2500X
WI16233-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)