Provider Demographics
NPI:1508115023
Name:MJ MOLLER CONSULTING & COUNSELING, LLC
Entity Type:Organization
Organization Name:MJ MOLLER CONSULTING & COUNSELING, LLC
Other - Org Name:INTRINSICUM POTENTIA COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JUDSON
Authorized Official - Last Name:MOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:612-280-0475
Mailing Address - Street 1:366 SELBY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2886
Mailing Address - Country:US
Mailing Address - Phone:612-280-0475
Mailing Address - Fax:651-224-4354
Practice Address - Street 1:366 SELBY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2886
Practice Address - Country:US
Practice Address - Phone:612-280-0475
Practice Address - Fax:651-224-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty