Healthcare Provider Details

I. General information

NPI: 1730385055
Provider Name (Legal Business Name): JAMIE MICHELLE MOHN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 W OLYMPIC BLVD #358
LOS ANGELES CA
90064-1608
US

IV. Provider business mailing address

11693 SAN VICENTE BLVD #500
LOS ANGELES CA
90049-5105
US

V. Phone/Fax

Practice location:
  • Phone: 310-471-1368
  • Fax:
Mailing address:
  • Phone: 310-471-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21491
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21491
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY21491
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY21491
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY21491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: