Provider Demographics
NPI:1083947295
Name:MOSER, MICHELLE DENISE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DENISE
Last Name:MOSER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 PERLICH AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2977
Mailing Address - Country:US
Mailing Address - Phone:651-301-1369
Mailing Address - Fax:651-388-4850
Practice Address - Street 1:309 BUSH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2505
Practice Address - Country:US
Practice Address - Phone:651-301-1369
Practice Address - Fax:651-388-4850
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist