Provider Demographics
NPI:1598937989
Name:LEE, MORONARD (LMFT)
Entity Type:Individual
Prefix:
First Name:MORONARD
Middle Name:
Last Name:LEE
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 1:9306 HARPERS CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6756
Mailing Address - Country:US
Mailing Address - Phone:763-688-4313
Mailing Address - Fax:
Practice Address - Street 1:970 RAYMOND AVE STE 106
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1164
Practice Address - Country:US
Practice Address - Phone:651-358-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3747P1801X
MN4350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant