Provider Demographics
NPI:1336217454
Name:MOSHER, JAMES K (PHD, ABPP, LP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:MOSHER
Suffix:
Gender:M
Credentials:PHD, ABPP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 AMERICAN BLVD E STE 212
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1393
Mailing Address - Country:US
Mailing Address - Phone:612-357-7723
Mailing Address - Fax:612-677-3099
Practice Address - Street 1:900 AMERICAN BLVD E STE 212
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1393
Practice Address - Country:US
Practice Address - Phone:612-357-7723
Practice Address - Fax:612-677-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019156103TC0700X
MI6301019263103TC0700X
MNLP6039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical