| Cedar Creek Psychological Services Llc | |
|
1235 Oak Trail Ct Fort Wayne IN 46845-6120 | |
| (260) 348-8031 | |
| Not Available |
| Full Name | Cedar Creek Psychological Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1235 Oak Trail Ct, Fort Wayne, Indiana |
| Authorized Official Name and Position | Matthew Robert Moeller (OWNER) |
| Authorized Official Contact | 2603488031 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Creek Psychological Services Llc 1235 Oak Trail Ct Fort Wayne IN 46845-6120 Ph: (260) 348-8031 | Cedar Creek Psychological Services Llc 1235 Oak Trail Ct Fort Wayne IN 46845-6120 Ph: (260) 348-8031 |
| NPI Number | 1316542830 |
|---|---|
| Provider Enumeration Date | 12/02/2020 |
| Last Update Date | 12/02/2020 |
| Certification Date | 12/02/2020 |
| Medicare PECOS PAC ID | 0941615181 |
|---|---|
| Medicare Enrollment ID | O20210219001752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316542830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Katherine Elizabeth Moeller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689050460 PECOS PAC ID: 9537574785 Enrollment ID: I20210219001997 |
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