Healthcare Provider Details

I. General information

NPI: 1932533197
Provider Name (Legal Business Name): LIBERTY A MCCLEAD LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 8TH ST S STE 200
MOORHEAD MN
56560-4200
US

IV. Provider business mailing address

2405 8TH ST S STE 200
MOORHEAD MN
56560-4200
US

V. Phone/Fax

Practice location:
  • Phone: 218-331-4866
  • Fax: 218-331-4867
Mailing address:
  • Phone: 218-331-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006511
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33215
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: