| Doctor Name: | DR. JASON LAGRAND MOURITSEN |
| NPI Number: | 1033547724 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | 1805 |
| Business Practice Address: | 1 Jarrett White Rd Tripler Army Medical Center, HI - 968595001 |
| Business Phone Number: | 8084332643 |
| Business Fax Number: | |
| Mailing Address: | 94-238 Haea Pl, WAIPAHU |
| State: | HI |
| Postal Code: | 967975455 |
| Phone Number: | 8474544677 |
| Fax Number: | |
| NPI Enumeration Date: | 10/16/2013 |
| NPI Last Update Date: | 10/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1805 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |