Provider Demographics
NPI:1467702076
Name:TRUAX, PEGANN MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:PEGANN
Middle Name:MARIE
Last Name:TRUAX
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14897 BITTERSWEET CT
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-3142
Mailing Address - Country:US
Mailing Address - Phone:651-276-2385
Mailing Address - Fax:612-656-3054
Practice Address - Street 1:5878 BLACKSHIRE PATH
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1621
Practice Address - Country:US
Practice Address - Phone:651-276-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health