Moontree Psychotherapy Center, Llc
LBN: Moontree Psychotherapy Center, Llc
Moontree Psychotherapy Center, Llc is an health care organization with primary practice located at 401 Wisconsin Ave , Madison WI 53703-1487. The organization recently has only one registered license in Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), which is considered as the primary health care specialty.
Moontree Psychotherapy Center, Llc can be contacted via phone (608) 256-5115, or through Decker, Dale via phone (608) 256-5115.
Contact Information
Primary practice address
401 Wisconsin Ave
Madison WI 53703-1487
Phone: (608) 256-5115
Fax: (608) 256-5116
Website:
Authorized official contact:
Name: Decker, Dale Licensed Clinical Social Worker (LCSW)
Phone: (608) 256-5115
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) | 261QM0801X | 1916 | Wisconsin |
Profile Details
| NPI number | 1598981318 |
|---|---|
| LBN Legal business name | Moontree Psychotherapy Center, Llc |
| DBA Doing business as | |
| Authorized official | Decker, Dale Licensed Clinical Social Worker (LCSW) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 18th, 2007 |
| Last updated | Aug 22nd, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598981318 | NPPES |
| Wisconsin | MEDICAID | 42174900 | |
| Wisconsin | Other | 84950 |
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