Organization
JESOLA INC
Active
Other names
Lakes Counseling Center
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA RAE MOENCH BS, LADC (OWNER/DIRECTOR)
(218) 396-0288
Entity
Organization
Contact information
Practice address
1000 8TH ST SE, STE A, DETROIT LAKES, MN 56501-2819
(218) 847-0696
(218) 847-4198
Mailing address
1000 8TH ST SE, STE A, DETROIT LAKES, MN 56501-2819
(218) 847-0696
(218) 847-4198
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
903109000
—
MN
Enumeration date
06/14/2005
Last updated
12/10/2024
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