Healthcare Provider Details

I. General information

NPI: 1386558542
Provider Name (Legal Business Name): MORAN PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 4TH AVE NW
AUSTIN MN
55912-3140
US

IV. Provider business mailing address

1009 36TH ST NW
AUSTIN MN
55912-6661
US

V. Phone/Fax

Practice location:
  • Phone: 507-438-2010
  • Fax: 507-434-0955
Mailing address:
  • Phone: 507-438-2010
  • Fax: 507-434-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TODD FRANCIS MORAN
Title or Position: CEO
Credential: PHD, LICSW
Phone: 507-438-2010