Provider Demographics
NPI:1326866823
Name:MOULZOLF, TRISTEN (LPCC)
Entity type:Individual
Prefix:
First Name:TRISTEN
Middle Name:
Last Name:MOULZOLF
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 1:150 10TH ST NW STE 2
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-1737
Mailing Address - Country:US
Mailing Address - Phone:320-983-2335
Mailing Address - Fax:651-342-8029
Practice Address - Street 1:1000 S BENTON DR UNIT 415
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1232
Practice Address - Country:US
Practice Address - Phone:320-309-0274
Practice Address - Fax:651-342-8029
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional