MEDICARE: MICHAEL E. MOATS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3661	CO

General Provider Information

NPI Number	:	1538454921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E. MOATS PSYD

Provider Business Mailing Address
First Line	:	8055 CANDLEFLOWER CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-5751
Country	:	US
Telephone Number	:	719-459-1355
Fax Number	:

Provider Business Practice Location Address
First Line	:	8055 CANDLEFLOWER CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-5751
Country	:	US
Telephone Number	:	719-459-1355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	07/12/2024

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