Healthcare Provider Details

I. General information

NPI: 1942814025
Provider Name (Legal Business Name): BEN MOSEBACH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

IV. Provider business mailing address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

V. Phone/Fax

Practice location:
  • Phone: 541-841-8110
  • Fax: 541-851-8114
Mailing address:
  • Phone: 541-841-8110
  • Fax: 541-851-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR6252
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: