Individual
MR. LUCAS JOHN MOULDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPCC
Contact information
Practice address
7580 160TH ST W, LAKEVILLE, MN 55044-8348
(952) 892-0897
(952) 435-6797
Mailing address
7580 160TH ST W, LAKEVILLE, MN 55044-8348
(952) 892-0897
(952) 435-6797
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC01674
MN
Other
Enumeration date
12/15/2017
Last updated
12/15/2017
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