Provider Demographics
NPI:1073011227
Name:MOUA, MAY YIA LEE (LPCC, (PRE-LICENSED))
Entity Type:Individual
Prefix:MRS
First Name:MAY
Middle Name:YIA LEE
Last Name:MOUA
Suffix:
Gender:F
Credentials:LPCC, (PRE-LICENSED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10129 COUNTRY CLUB CURV
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-4212
Mailing Address - Country:US
Mailing Address - Phone:651-303-2397
Mailing Address - Fax:
Practice Address - Street 1:241 VAN BUREN ST STE 4B
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1784
Practice Address - Country:US
Practice Address - Phone:763-308-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty