Provider Demographics
NPI:1720500564
Name:MOHR, EMILY ERIN
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:ERIN
Last Name:MOHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 11TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST. PETE
Mailing Address - State:FL
Mailing Address - Zip Code:33704
Mailing Address - Country:US
Mailing Address - Phone:727-488-5799
Mailing Address - Fax:
Practice Address - Street 1:2710 11TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2608
Practice Address - Country:US
Practice Address - Phone:727-488-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106E00000XMedicaid