Provider Demographics
NPI:1386982783
Name:MOHR, KATIE SUSAN (MA, LMFT, LPC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:SUSAN
Last Name:MOHR
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 GRAND AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2628
Mailing Address - Country:US
Mailing Address - Phone:612-619-7611
Mailing Address - Fax:
Practice Address - Street 1:1154 GRAND AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2628
Practice Address - Country:US
Practice Address - Phone:612-619-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist