| 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 |
| Location | 401 Wisconsin Ave, Madison, Wisconsin |
| Authorized Official Name and Position | Dale Decker (MEMBER) |
| Authorized Official Contact | 6082565115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 | 1770806259 |
|---|---|
| Provider Enumeration Date | 03/11/2010 |
| Last Update Date | 03/19/2024 |
| Certification Date | 03/19/2024 |
| Medicare PECOS PAC ID | 3274660295 |
|---|---|
| Medicare Enrollment ID | O20100423000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770806259 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1916 (Wisconsin) | Primary |
| Provider Name | Cindy S Richgels |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174533939 PECOS PAC ID: 3375524275 Enrollment ID: I20040526001382 |
| Provider Name | Cindy A Rosner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740403534 PECOS PAC ID: 7618004631 Enrollment ID: I20100423000271 |
| Provider Name | Rita R Hockers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194844415 PECOS PAC ID: 4981731908 Enrollment ID: I20100423000364 |
| Provider Name | Carol Veneta Nickles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780138776 PECOS PAC ID: 6103177092 Enrollment ID: I20180918000111 |
| Provider Name | Abbey Marie Scherer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972876407 PECOS PAC ID: 2365880853 Enrollment ID: I20240403000840 |
| Provider Name | Barbara Jean Knutson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801941927 PECOS PAC ID: 0345688834 Enrollment ID: I20240403000901 |
| Provider Name | Rebecca Marie Gebhart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104190438 PECOS PAC ID: 1052694429 Enrollment ID: I20240403002148 |
| Provider Name | Elizabeth Maureen Reeder |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1942555321 PECOS PAC ID: 3870804990 Enrollment ID: I20240403002687 |
| Provider Name | Emily Ann Mertens |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1023406899 PECOS PAC ID: 4284072729 Enrollment ID: I20240403002889 |
| Provider Name | David Krych |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528483088 PECOS PAC ID: 6406294818 Enrollment ID: I20240404001508 |
| Provider Name | Merija Eisen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790941953 PECOS PAC ID: 9537501747 Enrollment ID: I20240520002127 |
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