Provider Demographics
NPI:1730317132
Name:MONGER, TODD JEFFREY (LPCC, NCC, ACS)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:JEFFREY
Last Name:MONGER
Suffix:
Gender:M
Credentials:LPCC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 HOMESTEAD TRL
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-9687
Mailing Address - Country:US
Mailing Address - Phone:952-221-5625
Mailing Address - Fax:
Practice Address - Street 1:680 GAME FARM RD N
Practice Address - Street 2:
Practice Address - City:MAPLE PLAIN
Practice Address - State:MN
Practice Address - Zip Code:55359
Practice Address - Country:US
Practice Address - Phone:952-221-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health