Healthcare Provider Details

I. General information

NPI: 1770181125
Provider Name (Legal Business Name): CHRISTOPHER MOYLAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE A22
GREENVILLE SC
29615-3593
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-5115
  • Fax: 864-454-5111
Mailing address:
  • Phone: 864-522-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.1645
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1645
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: