Provider Demographics
NPI:1750332037
Name:MOUSSETTE, JOANNE G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:G
Last Name:MOUSSETTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 GREENBRIAR DR
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6425
Mailing Address - Country:US
Mailing Address - Phone:217-546-3118
Mailing Address - Fax:217-546-3184
Practice Address - Street 1:2921 GREENBRIAR DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6425
Practice Address - Country:US
Practice Address - Phone:217-546-3118
Practice Address - Fax:217-546-3184
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL265199OtherHEALTH LINK
IL064592OtherHEALTH ALLIANCE
ILL82921OtherMEDICARE
IL159421 (MHS)OtherVALUE OPTIONS
IL5932532OtherAETNA