Provider Demographics
NPI:1891185625
Name:MOESLEIN, LAURA MARIE
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:MOESLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-2133
Mailing Address - Country:US
Mailing Address - Phone:269-273-0606
Mailing Address - Fax:269-273-0607
Practice Address - Street 1:716 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-2133
Practice Address - Country:US
Practice Address - Phone:269-273-0606
Practice Address - Fax:269-273-0607
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016219103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling