Provider Demographics
NPI:1134301377
Name:MOISEYEV, ANDREY YUREIVICH III (MA)
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:YUREIVICH
Last Name:MOISEYEV
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FOUNTAIN ST
Mailing Address - Street 2:P.O. BOX 1186, 47902
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1731
Mailing Address - Country:US
Mailing Address - Phone:765-742-5046
Mailing Address - Fax:765-477-9905
Practice Address - Street 1:100 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5592
Practice Address - Country:US
Practice Address - Phone:765-742-4848
Practice Address - Fax:765-477-9905
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional