Individual
PATRICIA C MOISAN THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2020 UNION ST, STE 101, LAFAYETTE, IN 47904-3432
(765) 449-8286
(765) 449-0445
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20040188A
IN
103TC0700X
Clinical Psychologist
Primary
20040188A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100207030
—
IN
Enumeration date
03/14/2006
Last updated
08/14/2015
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