Provider Demographics
NPI:1407618010
Name:MOSER, HEATHER (LMAC, LAPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MOSER
Suffix:
Gender:
Credentials:LMAC, LAPC
Other - Prefix:
Other - First Name:IMPACT
Other - Middle Name:
Other - Last Name:THERAPY, PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3426 BAY SHORE BND SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-6259
Mailing Address - Country:US
Mailing Address - Phone:701-516-6980
Mailing Address - Fax:
Practice Address - Street 1:3426 BAY SHORE BND SE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-6259
Practice Address - Country:US
Practice Address - Phone:701-516-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ND1912101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty