Provider Demographics
NPI:1902298938
Name:MOELLER, LEONARD (LAMFT)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:MOELLER
Suffix:
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-2310
Mailing Address - Country:US
Mailing Address - Phone:651-280-7939
Mailing Address - Fax:
Practice Address - Street 1:550 COUNTY ROAD D W
Practice Address - Street 2:SUITE 10
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-3517
Practice Address - Country:US
Practice Address - Phone:651-644-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLAMFT 3048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist