NPIMap

Organization Active NPI

Moontree Psychotherapy Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madison, WI
National Provider Identifier
1770806259
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
1916 Issued in WI
Legal business name
MOONTREE PSYCHOTHERAPY CENTER LLC
Practice address
401 Wisconsin Ave
Madison, WI 53703-1487
Phone
(608) 256-5115
Fax
(608) 256-5116
NPI assigned
Mar 11, 2010
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Dale Decker, LCSWNPI 1609993468
Title
Member
Phone
(608) 256-5115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 1916 WI Primary

Addresses

Primary practice location

401 Wisconsin Ave
Madison, WI 53703-1487

Mailing address

401 Wisconsin Ave
Madison, WI 53703-1487
Phone (608) 256-5115

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100423000213 WI Part B Supplier - Clinic/Group Practice 3274660295 Receives reassigned benefits from 15 practitioners
Practice locations: Madison, WI

National Provider Directory

National Provider Directory

Locations

401 Wisconsin Ave
Madison, WI 53703
Phone (608) 256-5115

401 Wisconsin Ave
Fl 2
Madison, WI 53703
Phone (608) 256-5115

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1770806259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 WISCONSIN AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537031487",
            "telephone_number": "608-256-5115",
            "fax_number": "608-256-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 WISCONSIN AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537031487",
            "telephone_number": "608-256-5115",
            "fax_number": "608-256-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONTREE PSYCHOTHERAPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "DECKER",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "608-256-5115",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "1916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.