Tristen Moulzolf, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4597 Issued in MN

Practice address

1000 S Benton Dr Unit 415
Sauk Rapids, MN 56379-1232

Phone

(320) 309-0274

Fax

(651) 342-8029

NPI assigned

Oct 2, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lighthouse Child & Family Services

  • Community/Behavioral Health Agency
  • Foley, MN
  • NPI 1689861197
  Medicare reassignment NPD
• Awakened Connections Therapy

  • Clinical Social Worker
  • Milaca, MN
  • NPI 1205632346
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1326866823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 10TH ST NW STE 2",
            "city": "MILACA",
            "state": "MN",
            "postal_code": "563531737",
            "telephone_number": "320-983-2335",
            "fax_number": "651-342-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BENTON DR UNIT 415",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563791232",
            "telephone_number": "320-309-0274",
            "fax_number": "651-342-8029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULZOLF",
        "first_name": "TRISTEN",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-02",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Miller, MA, CCC-SLP
• Abdirahman Aabdikadur Mohamed
• Ibrahim Ahmed Mohamed
• Nimo Deeq Mohamud
• Kailee Monson
• Abdurahman Osman Mukhtar
• MW Minnetonka Operating LLC
• MW Sauk Rapids Operating, LLC
• Debra Nagel
• Amber Nichol Nelson

• Professional Counselor in Sauk Rapids, MN
• Providers in Sauk Rapids, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.