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General NPI Number Information
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NPI Number | 1730317132
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Entity Type | Individual
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Provider Name | TODD JEFFREY MONGER LPCC, NCC, ACS
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Gender | Male
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 680 GAME FARM RD N
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City | MAPLE PLAIN
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State | MN
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Zip | 55359
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Country | US
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Telephone | 952-221-5625
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Fax |
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Provider Business Mailing Address
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Address Line | 1272 HOMESTEAD TRL
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City | LONG LAKE
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State | MN
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Zip | 55356-9687
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Country | US
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Telephone | 952-221-5625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 00034
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License Number State | MN
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