Provider Demographics
NPI:1255856928
Name:MOYLAN, JULIE ANN (MA, LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:MOYLAN
Suffix:
Gender:F
Credentials:MA, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CHERRY ST W APT 3
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6771
Mailing Address - Country:US
Mailing Address - Phone:651-494-4583
Mailing Address - Fax:
Practice Address - Street 1:116 CHESTNUT ST E # 150
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5116
Practice Address - Country:US
Practice Address - Phone:651-494-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304182101YA0400X
MN01861101YM0800X
MN1896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)