Michael J Moller PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2320-057 Issued in WI

Legal business name

MICHAEL J MOLLER PA

Practice address

900 6TH St N
Suite 102
Hudson, WI 54016-7171

Phone

(715) 386-0856

Fax

(715) 386-0948

NPI assigned

Jan 11, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Michael J Moller, PSYD, LP, ABPPNPI 1578647004

Title

Owner

Phone

(715) 386-0856

Specialties & licenses 15

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael J Moller, PSYD

  • Clinical Psychologist
  • Hudson, WI
  • NPI 1578647004
  NPD (past) Authorized official

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

{
    "created_epoch": "1294704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294704000000",
    "number": "1992000657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 6TH ST N",
            "address_2": "SUITE 102",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167171",
            "telephone_number": "715-386-0856",
            "fax_number": "715-386-0948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 6TH ST N",
            "address_2": "SUITE 102",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167171",
            "telephone_number": "715-386-0856",
            "fax_number": "715-386-0948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J MOLLER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-11",
        "last_updated": "2011-01-11",
        "status": "A",
        "authorized_official_last_name": "MOLLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-386-0856",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LP, ABPP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2320-057",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3404",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "WI",
            "license": "2320-057",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "WI",
            "license": "2320-057",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LP3404",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2320-057",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3404",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "WI",
            "license": "2320-057",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WI",
            "license": "2320-057",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP3404",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": "WI",
            "license": "2320-057",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": "WI",
            "license": "2320-057",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": "MN",
            "license": "LP3404",
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Psychoanalysis",
            "state": "WI",
            "license": "2320-057",
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Psychoanalysis",
            "state": "MN",
            "license": "LP3404",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "880824400",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39739300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Hudson, WI
• Providers in Hudson, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.