Provider Demographics
NPI:1275008088
Name:MOLAOLI, MOEKETSI III (LPC)
Entity Type:Individual
Prefix:MR
First Name:MOEKETSI
Middle Name:
Last Name:MOLAOLI
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:MOEKETSI
Other - Middle Name:
Other - Last Name:MOLAOLI
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:305 E BUSINESS HIGHWAY 151 STE D
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3767
Mailing Address - Country:US
Mailing Address - Phone:414-649-1667
Mailing Address - Fax:
Practice Address - Street 1:305 E BUSINESS HIGHWAY 151 STE D
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3767
Practice Address - Country:US
Practice Address - Phone:414-649-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8092-125101YP2500X
WI3692-125103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124415740Medicaid
WI1124415740Medicaid