Organization
MOONTREE PSYCHOTHERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE DECKER LCSW (PSYCHOTHERAPIST)
(608) 256-5115
Entity
Organization
Contact information
Practice address
401 WISCONSIN AVE, MADISON, WI 53703-1487
(608) 256-5115
(608) 256-5116
Mailing address
401 WISCONSIN AVE, MADISON, WI 53703-1487
(608) 256-5115
(608) 256-5116
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1916
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42174900
—
WI
01
—
84950
WPS
WI
Enumeration date
04/18/2007
Last updated
08/22/2020
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