Provider Demographics
NPI:1770964694
Name:MOUA, HONEY (LGSW)
Entity type:Individual
Prefix:
First Name:HONEY
Middle Name:
Last Name:MOUA
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 SAINT CLAIR AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2819
Mailing Address - Country:US
Mailing Address - Phone:715-577-7159
Mailing Address - Fax:
Practice Address - Street 1:500 GROTTO ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1754
Practice Address - Country:US
Practice Address - Phone:651-760-3236
Practice Address - Fax:651-222-6025
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN241171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical