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General NPI Number Information
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NPI Number | 1891260535
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Entity Type | Individual
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Provider Name | JUSTIN MOSLING MS LPC CSAC
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Gender | Male
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 13000 W BLUEMOUND RD # 300
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City | ELM GROVE
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State | WI
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Zip | 53122-2650
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Country | US
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Telephone | 262-785-9188
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Fax |
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Provider Business Mailing Address
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Address Line | N52W14104 ABERDEEN DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-6828
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Country | US
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Telephone | 608-397-4353
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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 | 5566-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16233-132
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License Number State | WI
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