Organization
MASON MOORE CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ALLISON MOORE PHD LP (OWNER)
(952) 925-5343
Entity
Organization
Contact information
Practice address
5009 EXCELSIOR BLVD STE 136, ST LOUIS PARK, MN 55416-3049
(952) 925-5343
Mailing address
5009 EXCELSIOR BLVD STE 136, ST LOUIS PARK, MN 55416-3049
(952) 925-5343
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2399
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11934MO
BCBS GROUP NUMBER
MN
01
—
6109358
MEDICA ID
MN
Enumeration date
12/28/2006
Last updated
09/26/2007
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