Provider Demographics
NPI:1871078162
Name:MOEN, RITA MARIE (LPCC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MARIE
Last Name:MOEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-0066
Mailing Address - Country:US
Mailing Address - Phone:218-435-1356
Mailing Address - Fax:
Practice Address - Street 1:903 S. HILLIGOSS BLVD. EAST
Practice Address - Street 2:SUITE A
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542
Practice Address - Country:US
Practice Address - Phone:218-435-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
MN1885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health