Provider Demographics
NPI:1144599432
Name:MICHAEL MOATS, PSYD, INC.
Entity Type:Organization
Organization Name:MICHAEL MOATS, PSYD, INC.
Other - Org Name:CARPE DIEM, FLINKERBEANS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOATS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-459-1355
Mailing Address - Street 1:224 E WILLAMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1114
Mailing Address - Country:US
Mailing Address - Phone:719-459-1355
Mailing Address - Fax:719-448-9467
Practice Address - Street 1:224 E WILLAMETTE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1114
Practice Address - Country:US
Practice Address - Phone:719-459-1355
Practice Address - Fax:719-448-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3661251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health