Individual
MICHAEL GRAHAM WAXLAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC, LPCC
Contact information
Practice address
230 1ST ST, MORA, MN 55051-1330
(218) 969-1943
Mailing address
2031 ROWLAND RD, MORA, MN 55051-7119
(320) 364-1300
(651) 323-2558
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303086
MN
101YP2500X
Professional Counselor
Primary
4158
MN
Other
Enumeration date
12/01/2022
Last updated
03/06/2024
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