Provider Demographics
NPI:1437559648
Name:MOSLEY, JAMIE (MS, LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ROGERS DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374
Mailing Address - Country:US
Mailing Address - Phone:815-973-0999
Mailing Address - Fax:763-657-0819
Practice Address - Street 1:2100 ROGERS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374
Practice Address - Country:US
Practice Address - Phone:815-973-0999
Practice Address - Fax:763-657-0819
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional