Organization
MICHAEL J MOLLER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J MOLLER PSYD, LP, ABPP (OWNER)
(715) 386-0856
Entity
Organization
Contact information
Practice address
900 6TH ST N, SUITE 102, HUDSON, WI 54016-7171
(715) 386-0856
(715) 386-0948
Mailing address
900 6TH ST N, SUITE 102, HUDSON, WI 54016-7171
(715) 386-0856
(715) 386-0948
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2320-057
WI
103T00000X
Psychologist
LP3404
MN
103TA0700X
Adult Development & Aging Psychologist
2320-057
WI
103TB0200X
Cognitive & Behavioral Psychologist
2320-057
WI
103TB0200X
Cognitive & Behavioral Psychologist
LP3404
MN
103TC0700X
Clinical Psychologist
2320-057
WI
103TC0700X
Clinical Psychologist
LP3404
MN
103TC1900X
Counseling Psychologist
2320-057
WI
103TC2200X
Clinical Child & Adolescent Psychologist
2320-057
WI
103TC2200X
Clinical Child & Adolescent Psychologist
LP3404
MN
103TF0000X
Family Psychologist
2320-057
WI
103TF0200X
Forensic Psychologist
2320-057
WI
103TF0200X
Forensic Psychologist
LP3404
MN
103TP0814X
Psychoanalysis Psychologist
2320-057
WI
103TP0814X
Psychoanalysis Psychologist
LP3404
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39739300
—
WI
05
—
880824400
—
MN
Enumeration date
01/11/2011
Last updated
01/11/2011
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