Provider Demographics
NPI:1376913129
Name:IN THE MOMENT CHILD AND FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:IN THE MOMENT CHILD AND FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MOFFETT
Authorized Official - Last Name:HARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:608-436-0506
Mailing Address - Street 1:653 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53536-1067
Mailing Address - Country:US
Mailing Address - Phone:608-436-0506
Mailing Address - Fax:
Practice Address - Street 1:6705 WESNER RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9178
Practice Address - Country:US
Practice Address - Phone:608-620-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI478-228251S00000X
WI2694-226251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health