Provider Demographics
NPI:1558899732
Name:MOOS, ASHLEY THERESE (MS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:THERESE
Last Name:MOOS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:THERESE
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4215 W CALVARY RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1256
Mailing Address - Country:US
Mailing Address - Phone:218-721-2126
Mailing Address - Fax:
Practice Address - Street 1:332 W SUPERIOR ST STE 300
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1844
Practice Address - Country:US
Practice Address - Phone:218-722-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health