Provider Demographics
NPI:1023508918
Name:ROBERT MOESTA EVALUATION AND TREATMENT SERVICES
Entity type:Organization
Organization Name:ROBERT MOESTA EVALUATION AND TREATMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOESTA
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:734-945-7490
Mailing Address - Street 1:203 W MICHIGAN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1355
Mailing Address - Country:US
Mailing Address - Phone:734-470-6908
Mailing Address - Fax:734-470-6443
Practice Address - Street 1:203 W MICHIGAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1355
Practice Address - Country:US
Practice Address - Phone:734-470-6908
Practice Address - Fax:734-470-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty