Provider Demographics
NPI:1699880021
Name:MOSIER, JULIE IVORY (PHD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:IVORY
Last Name:MOSIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 TOWN CENTER PL
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3714
Mailing Address - Country:US
Mailing Address - Phone:281-361-0777
Mailing Address - Fax:281-361-5777
Practice Address - Street 1:4439 TOWN CENTER PL
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3714
Practice Address - Country:US
Practice Address - Phone:281-361-0777
Practice Address - Fax:281-361-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32215103TC0700X
TX32597103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86996AOtherBCBS PROVIDER ID NUMBER