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General NPI Number Information
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NPI Number | 1154777894
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Entity Type | Organization
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Legal Business Name | MOCHINA, LLC
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 12741 RESEARCH BLVD SUITE 301
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City | AUSTIN
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State | TX
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Zip | 78759-4388
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Country | US
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Telephone | 614-802-1958
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Fax |
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Provider Business Mailing Address
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Address Line | 12741 RESEARCH BLVD SUITE 301
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City | AUSTIN
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State | TX
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Zip | 78759-4388
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Country | US
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Telephone | 614-802-1958
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES SHAW
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Credential | PHD
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Telephone | 614-802-1958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 34284
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License Number State | TX
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