Provider Demographics
NPI:1699815654
Name:VOIGHT-MOLLER, MARY KAY ELIZABETH (LP)
Entity Type:Individual
Prefix:MS
First Name:MARY KAY
Middle Name:ELIZABETH
Last Name:VOIGHT-MOLLER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14316 UPPER 56TH ST N
Mailing Address - Street 2:
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6442
Mailing Address - Country:US
Mailing Address - Phone:651-430-3119
Mailing Address - Fax:
Practice Address - Street 1:333 GRAND AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2582
Practice Address - Country:US
Practice Address - Phone:651-227-8105
Practice Address - Fax:651-227-8106
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2949103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist