Active NPI
David Holtan Moll, MS, LP
- Psychologist
- Owatonna, MN
National Provider Identifier
1124117544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP 4859
- Practice address
- 610 Florence Ave
Owatonna, MN 55060-4704 - Phone
- (507) 451-2630
- Fax
- (507) 455-8133
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP 4859 | MN | Primary |
Addresses
Primary practice location
610 Florence Ave
Owatonna, MN 55060-4704
Mailing address
610 Florence Ave
Owatonna, MN 55060-4704
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 793323100 | Medicaid | MN | |
| 62-20365 | Other | MN | UNITED BEHAVIORAL HEALTH |
| HP27427 | Other | MN | HEALTH PARTNERS |
| 126989 | Other | MN | UCARE |
| 15G19MO | Other | MN | BLUE CROSS BLUE SHIELD |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | messagec@direct.schrc.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP 4859 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613347200000",
"number": "1124117544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 FLORENCE AVE",
"city": "OWATONNA",
"state": "MN",
"postal_code": "550604704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 FLORENCE AVE",
"city": "OWATONNA",
"state": "MN",
"postal_code": "550604704",
"telephone_number": "507-451-2630",
"fax_number": "507-455-8133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLL",
"first_name": "DAVID",
"middle_name": "HOLTAN",
"credential": "MS, LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2021-02-15",
"certification_date": "2021-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP 4859",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "793323100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "62-20365",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP27427",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "126989",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "15G19MO",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "messagec@direct.schrc.com",
"affiliation": "N",
"address_1": "610 Florence Ave",
"city": "Owatonna",
"state": "MN",
"country_code": "US",
"postal_code": "550604704",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Owatonna, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.