Moonlight Psychotherapy and Psychological Services, LLC
NPI 1972075661ActiveOrganization· Psychologist, Clinical· La Crosse, WI
Psychologist, Clinical in La Crosse, Wisconsin, registered in NPPES in December 2018. The authorized official on file is Frederick William Green, PSY.D., LP, Owner / Psychologist. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1972075661 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 19, 2018 |
| Last updated in NPPES | Dec 19, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MA) |
|---|
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