Cedar Creek Psychological Services LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

CEDAR CREEK PSYCHOLOGICAL SERVICES LLC

Practice address

1235 Oak Trail CT
Fort Wayne, IN 46845-6120

Phone

(260) 348-8031

NPI assigned

Dec 2, 2020

Last updated

Dec 2, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Robert Moeller

Title

Owner

Phone

(260) 348-8031

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katherine Moeller, PSY.D., HSPP

  • Clinical Psychologist
  • Fort Wayne, IN
  • NPI 1689050460
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606867200000",
    "number": "1316542830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 OAK TRAIL CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468456120",
            "telephone_number": "260-348-8031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 OAK TRAIL CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468456120",
            "telephone_number": "260-348-8031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREEK PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-02",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A",
        "authorized_official_last_name": "MOELLER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-348-8031"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.