Provider Demographics
NPI:1801253034
Name:MORELAND, JENNIFER ANN (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MORELAND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:TEASCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2705
Mailing Address - Country:US
Mailing Address - Phone:218-404-9611
Mailing Address - Fax:218-414-2600
Practice Address - Street 1:601 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2705
Practice Address - Country:US
Practice Address - Phone:218-404-9611
Practice Address - Fax:218-414-2600
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist