Provider Demographics
NPI:1548864051
Name:MOEN, ELIZABETH A (LPCC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MOEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 SHINGLE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2322
Mailing Address - Country:US
Mailing Address - Phone:763-569-5228
Mailing Address - Fax:763-569-5240
Practice Address - Street 1:5910 SHINGLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2322
Practice Address - Country:US
Practice Address - Phone:763-569-5228
Practice Address - Fax:763-569-5240
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health