MEDICARE: PEGANN MARIE TRUAX LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	816	MN

General Provider Information

NPI Number	:	1467702076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGANN MARIE TRUAX LPCC

Provider Business Mailing Address
First Line	:	5878 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1621
Country	:	US
Telephone Number	:	651-276-2385
Fax Number	:	612-656-3054

Provider Business Practice Location Address
First Line	:	5878 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1621
Country	:	US
Telephone Number	:	651-276-2385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	11/15/2024

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