Provider Demographics
NPI:1922404672
Name:MOYER, DON L (MSW, LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:L
Last Name:MOYER
Suffix:
Gender:M
Credentials:MSW, LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RAILROAD ST SE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1540
Mailing Address - Country:US
Mailing Address - Phone:320-629-7600
Mailing Address - Fax:651-925-0071
Practice Address - Street 1:1700 E RUM RIVER DR S STE B
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-2558
Practice Address - Country:US
Practice Address - Phone:651-224-4114
Practice Address - Fax:651-925-0071
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YA0400X
MN022031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN02203OtherLICSW