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General NPI Number Information
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NPI Number | 1780967042
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Entity Type | Individual
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Provider Name | TERESA A SOLBERG MOORE MA LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 7580 160TH ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-8348
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Country | US
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Telephone | 952-898-1133
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Fax | 952-435-6797
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Provider Business Mailing Address
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Address Line | 4590 SCOTT TRAIL STE 100
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City | EAGAN
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State | MN
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Zip | 55122
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Country | US
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Telephone | 612-532-6993
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Fax | 952-435-6797
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2163
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License Number State | MN
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