Kristin Lee Moen, MA, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC00603 Issued in MN

Practice address

13000 63Rd Ave N
Maple Grove, MN 55369-6081

Phone

(763) 553-4003

NPI assigned

Jun 18, 2013

Last updated

Jul 21, 2022By the provider in NPPES

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

Other names 1

• Kristin Lee Irwin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifespan of Minnesota, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Burnsville, MN
  • NPI 1710097274
  NPD

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

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1457790990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12425 RIVER RIDGE BLVD STE 200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374872",
            "telephone_number": "952-562-8500",
            "fax_number": "952-562-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13000 63RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696081",
            "telephone_number": "763-553-4003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "529 County Road E W",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Shoreview",
            "state": "MN",
            "postal_code": "551267072",
            "country_code": "US",
            "telephone_number": "952-562-8310",
            "fax_number": "952-562-8311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12425 River Ridge Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MN",
            "postal_code": "553374872",
            "country_code": "US",
            "telephone_number": "952-562-8500",
            "fax_number": "952-562-8801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOEN",
        "first_name": "KRISTIN",
        "middle_name": "LEE",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC00603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "IRWIN",
            "middle_name": "LEE",
            "credential": "MA, LPCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.