Provider Demographics
NPI:1750683561
Name:MOSHER, JODY L (MA LCPC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8028
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-8028
Mailing Address - Country:US
Mailing Address - Phone:406-529-5849
Mailing Address - Fax:
Practice Address - Street 1:314 N 1ST ST W
Practice Address - Street 2:UPPER
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3626
Practice Address - Country:US
Practice Address - Phone:406-529-5849
Practice Address - Fax:406-728-5178
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health