Provider Demographics
NPI:1801919519
Name:MOHR, VERNICE SALLY (PSY TECH)
Entity type:Individual
Prefix:MRS
First Name:VERNICE
Middle Name:SALLY
Last Name:MOHR
Suffix:
Gender:F
Credentials:PSY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5317
Mailing Address - Country:US
Mailing Address - Phone:209-331-2070
Mailing Address - Fax:209-331-2077
Practice Address - Street 1:1209 W TOKAY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3845
Practice Address - Country:US
Practice Address - Phone:209-331-2070
Practice Address - Fax:209-331-2077
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21167167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician