MOONLIGHT PSYCHOTHERAPY AND PSYCHOLOGICAL SERVICES, LLC
NPI 1972075661
Psychologist - Clinical in La Crosse, WI

Q: What is Moonlight Psychotherapy And Psychological Services, LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since December 19, 2018

205 5TH AVE S STE 428, LA CROSSE, WI 54601(207) 317-0557 Get Directions Write a Review

NPPES record last updated: December 19, 2018. Verified against the NPPES registry weekly; last sync: November 08, 2026.

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About Moonlight Psychotherapy And Psychological Services, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOONLIGHT PSYCHOTHERAPY AND PSYCHOLOGICAL SERVICES, LLC (NPI 1972075661) is a healthcare organization registered as a clinical in La Crosse, Wisconsin and active in the NPI registry since December 2018. The organization lists Frederick William Green, Owner / Psychologist, as its authorized official.

NPPES Registry Identity

NPI1972075661

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameMOONLIGHT PSYCHOTHERAPY AND PSYCHOLOGICAL SERVICES, LLC

Location Address205 5TH AVE S STE 428La Crosse, WI 54601-4059

Mailing Address1718 Sunset DrLa Crosse, WI 54601-7030 · (207) 317-0557

Phone(207) 317-0557

Organization SubpartNo

Authorized OfficialFrederick William GreenOwner / Psychologist · (207) 317-0557

Enumeration DateDecember 19, 2018

✔ NPI 1972075661 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

205 5TH AVE S STE 428, La Crosse, WI 54601

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Moonlight Psychotherapy And Psychological Services, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Moonlight Psychotherapy And Psychological Services, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Frederick Green, PSYD

Clinical Psychologist

NPI 1629451588

51 FAIRVIEW AVE
Rehoboth, MA 02769

(207) 317-0557

✔ PECOS1,022 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Moonlight Psychotherapy And Psychological Services, LLC's NPI number?

The NPI number for Moonlight Psychotherapy And Psychological Services, LLC is 1972075661. It was assigned to this organization in the NPPES registry on December 19, 2018.

Where is Moonlight Psychotherapy And Psychological Services, LLC located?

Moonlight Psychotherapy And Psychological Services, LLC is located at 205 5th Ave S Ste 428, La Crosse, WI 54601. The listed phone number is (207) 317-0557.

What is Moonlight Psychotherapy And Psychological Services, LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Moonlight Psychotherapy And Psychological Services, LLC enrolled in Medicare?

Yes. Moonlight Psychotherapy And Psychological Services, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Moonlight Psychotherapy And Psychological Services, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Moonlight Psychotherapy And Psychological Services, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Moonlight Psychotherapy And Psychological Services, LLC was last updated on December 19, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.