Provider Demographics
NPI:1952666190
Name:MOUA, MARIA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MOUA
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 1:78 6TH AVE, UNIT 52
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1667
Mailing Address - Country:US
Mailing Address - Phone:651-314-1812
Mailing Address - Fax:651-369-5560
Practice Address - Street 1:16408 XINGU ST NE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MN
Practice Address - Zip Code:55025-8867
Practice Address - Country:US
Practice Address - Phone:651-314-1812
Practice Address - Fax:651-369-5560
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist