MEDICARE: MORONARD LEE LMFT

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	3747P1801X	Personal Care Attendant		MN
2	106H00000X	Marriage & Family Therapist	4350	MN

General Provider Information

NPI Number	:	1598937989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORONARD LEE LMFT

Provider Business Mailing Address
First Line	:	9306 HARPERS CT NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-6756
Country	:	US
Telephone Number	:	763-688-4313
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 RAYMOND AVE STE 106
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1164
Country	:	US
Telephone Number	:	651-358-2227
Fax Number	:

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

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	02/08/2023

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