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General NPI Number Information
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NPI Number | 1205695970
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Entity Type | Individual
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Provider Name | MICHAEL JASON MOLOHON BA, MA, LSC, PLPC
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Gender | Male
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 4249 N SAINT PETERS PKWY # 5
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City | SAINT PETERS
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State | MO
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Zip | 63304-7441
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Country | US
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Telephone | 317-523-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 501 PELICAN ISLAND DR APT 5
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City | FLORISSANT
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State | MO
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Zip | 63031-8773
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Country | US
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Telephone | 317-523-0951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2024007361
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License Number State | MO
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