Individual
FRED T MOELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2084
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
241087000
MAGELLAN BEHAVIORAL HEALT
GA
05
—
324771962A
—
GA
Enumeration date
03/12/2007
Last updated
09/23/2010
Update your record
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