Mousinho joined League One club Preston North End on a free transfer on 29 May 2012, signing a two-year deal with the club. The move reunited him with former Stevenage manager Graham Westley. He was named as club captain for the 2012–13 season. Mousinho made his Preston debut in the club's opening game of the season on 13 August 2012, playing the whole match as Preston beat Championship team Huddersfield Town 2–0 at Deepdale He scored his first goal for the club on 1 January 2013, scoring the only goal of the game courtesy of a first-half header in a 1–0 away win against Hartlepool United. Mousinho made 29 appearances during the season, scoring once.