Provider Demographics
NPI:1205695970
Name:MOLOHON, MICHAEL JASON (BA, MA, LSC, PLPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JASON
Last Name:MOLOHON
Suffix:
Gender:M
Credentials:BA, MA, LSC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PELICAN ISLAND DR APT 5
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8773
Mailing Address - Country:US
Mailing Address - Phone:317-523-0951
Mailing Address - Fax:
Practice Address - Street 1:4249 N SAINT PETERS PKWY # 5
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63304-7441
Practice Address - Country:US
Practice Address - Phone:317-523-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024007361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional