Organization
MOONLIGHT PSYCHOTHERAPY AND PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK WILLIAM GREEN PSY.D., LP (OWNER / PSYCHOLOGIST)
(207) 317-0557
Entity
Organization
Contact information
Practice address
205 5TH AVE S STE 428, LA CROSSE, WI 54601-4059
(207) 317-0557
Mailing address
1718 SUNSET DR, LA CROSSE, WI 54601-7030
(207) 317-0557
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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