| Moontree Psychotherapy Center, Llc | |
|
401 Wisconsin Ave Madison WI 53703-1487 | |
| (608) 256-5115 | |
| (608) 256-5116 |
| Full Name | Moontree Psychotherapy Center, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 401 Wisconsin Ave, Madison, Wisconsin |
| Authorized Official Name and Position | Dale Decker (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6082565115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moontree Psychotherapy Center, Llc 401 Wisconsin Ave Madison WI 53703-1487 Ph: (608) 256-5115 | Moontree Psychotherapy Center, Llc 401 Wisconsin Ave Madison WI 53703-1487 Ph: (608) 256-5115 |
| NPI Number | 1598981318 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598981318 | NPI | - | NPPES |
| 42174900 | Medicaid | WI | |
| 84950 | Other | WI | WPS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1916 (Wisconsin) | Primary |
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