Organization
RICHELLE MOEN, PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHELLE NAOMI MOEN PHD (OWNER)
(612) 743-7788
Entity
Organization
Contact information
Practice address
4826 CHICAGO AVE STE 207, MINNEAPOLIS, MN 55417-1063
(612) 743-7788
(612) 824-7341
Mailing address
4826 CHICAGO AVE STE 207, MINNEAPOLIS, MN 55417-1063
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP2440
MN
Other
Enumeration date
02/14/2012
Last updated
02/14/2012
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