MOONLIGHT PSYCHOTHERAPY AND PSYCHOLOGICAL SERVICES, LLC (NPI# 1972075661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1972075661 |
Entity Type | Organization |
Organization Name | MOONLIGHT PSYCHOTHERAPY AND PSYCHOLOGICAL SERVICES, LLC |
Practice Address |
205 5th Ave S Ste 428 La Crosse WI 54601-4059 |
Mailing Address |
1718 Sunset Dr La Crosse WI 54601-7030 |
Practice Telephone | 2073170557 |
Mailing Telephone | 2073170557 |
Enumeration Date | 2018-12-19 |
Last Update Date | 2018-12-19 |
Authorized Official Name | DR. FREDERICK WILLIAM GREEN (OWNER / PSYCHOLOGIST) |
Authorized Official Telephone | 2073170557 |
Authorized Official Credential | PSY.D., LP |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers |
Street Address |
205 5TH AVE S STE 428 |
City | LA CROSSE |
State | WI |
Zip Code | 54601-4059 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891324265 | Meagan Mcrae | Student in an Organized Health Care Education/Training Program | 1725 State St., 4051 Health Science Center, La Crosse, WI 54601 | 2020-04-07 |
1255969671 | Erin Dingman | Student in an Organized Health Care Education/Training Program | 1751 State Street, 4051 Health Science Center, La Crosse, WI 54601 | 2020-03-31 |
1619505047 | Nicole Kay Lynch | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State St, La Crosse, WI 54601 | 2020-03-31 |
1174151757 | Jenna Sells | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
1740818301 | Katie Irene Tahtinen | Student in an Organized Health Care Education/Training Program | Uwl- 4051 Health Science Center, 1725 State St., La Crosse, WI 54601 | 2020-03-30 |
1932737517 | Margaret May Grimm | Student in an Organized Health Care Education/Training Program | Univesity of Wisconsin-la Crosse, 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
1831727312 | Matthew Timothy Axler | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
1093340473 | Denise Stinson | Technician | 1311 Badger St, Apt 505, La Crosse, WI 54601 | 2020-03-06 |
1922632397 | Ibrahim Ahsan | Pharmacist | 1105 Wi-16, La Crosse, WI 54601 | 2020-02-25 |
1750913356 | Liza R Collins | Massage Therapist | 1415 State Wi 16, La Crosse, WI 54601 | 2020-02-11 |
Find all providers in zip 54601 |
Taxonomy Code | 103TC0700X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | Clinical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265958375 | Kristen Marie Marin | Psychologist | University of Wisconsin-la Crosse, 1725 State Street, 2106 Centennial Hall, La Crosse, WI 54601-3742 | 2017-08-21 |
1255492799 | Karen Lee Corona-londre | Psychologist | 2515 Smith Valley Rd, La Crosse, WI 54601 | 2006-12-12 |
1003351016 | Carol Goulet | Psychologist | 800 West Ave S, La Crosse, WI 54601-8806 | 2016-12-29 |
1831452069 | Chelsea M Ale | Psychologist | 700 West Ave S, La Crosse, WI 54601-4783 | 2012-06-22 |
1275868564 | Adam H Minniear | Psychologist | 212 11th St S, La Crosse, WI 54601-4397 | 2009-10-05 |
1295897247 | Ronald W Schafer | Psychologist | 1707 Main St, La Crosse, WI 54601-4200 | 2006-12-15 |
1053392407 | David W Fruehling | Psychologist | 1836 South Ave, La Crosse, WI 54601-5429 | 2005-11-10 |
1801891056 | Kathryn A Baker | Psychologist | 1836 South Ave, La Crosse, WI 54601-5429 | 2005-06-15 |
1306841788 | James M Tarlano | Psychologist | 1836 South Ave, La Crosse, WI 54601-5429 | 2005-06-14 |
1104820935 | Kevin M Boland | Psychologist | 1836 South Ave, La Crosse, WI 54601-5429 | 2005-06-09 |
Find all providers in LA CROSSE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.