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General NPI Number Information
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NPI Number | 1023508918
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Entity Type | Organization
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Legal Business Name | ROBERT MOESTA EVALUATION AND TREATMENT SERVICES
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 203 W MICHIGAN AVE STE 202
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City | SALINE
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State | MI
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Zip | 48176-1355
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Country | US
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Telephone | 734-470-6908
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Fax | 734-470-6443
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Provider Business Mailing Address
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Address Line | 203 W MICHIGAN AVE STE 202
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City | SALINE
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State | MI
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Zip | 48176-1355
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Country | US
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Telephone | 734-470-6908
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Fax | 734-470-6443
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT K MOESTA
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Credential | LLP
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Telephone | 734-945-7490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301009756
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License Number State | MI
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