Provider Demographics
NPI:1508385857
Name:MOORE, JENNIFER DANLEE (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DANLEE
Last Name:MOORE
Suffix:
Gender:X
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 10TH AVE S APT 1011
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1381
Mailing Address - Country:US
Mailing Address - Phone:317-987-6394
Mailing Address - Fax:
Practice Address - Street 1:652 BIELENBERG DR STE 202
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4480
Practice Address - Country:US
Practice Address - Phone:651-317-3902
Practice Address - Fax:833-972-4801
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional