Provider Demographics
NPI:1649265281
Name:MOLBERG, JAMES T (LP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:T
Last Name:MOLBERG
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
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Mailing Address - Street 1:220 RAILROAD ST SE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1540
Mailing Address - Country:US
Mailing Address - Phone:320-629-7600
Mailing Address - Fax:320-629-7900
Practice Address - Street 1:900 GOLF AVE SW
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-5015
Practice Address - Country:US
Practice Address - Phone:320-629-7600
Practice Address - Fax:320-629-7900
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3801103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114812OtherUCARE MN
MN6253648OtherUNITED BEHAVIORAL HEALTH
MN1032821OtherBEHAVIORAL HEALTHCARE PRO
MN522222200Medicaid
HP37571OtherHEALTH PARTNERS
MN233J0M0OtherBCBS