Provider Demographics
NPI:1033547724
Name:MOURITSEN, JASON LAGRAND (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LAGRAND
Last Name:MOURITSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:NV
Mailing Address - Zip Code:89001-0436
Mailing Address - Country:US
Mailing Address - Phone:725-222-0461
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 436
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:NV
Practice Address - Zip Code:89001-0436
Practice Address - Country:US
Practice Address - Phone:725-222-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0794103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty