Doctor Name: | DR. LILLIAN M. MOELLER |
NPI Number: | 1215096904 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 1558 |
Business Practice Address: | 10 Boulder Crescent St Ste 101b Colorado Springs, CO - 809033344 |
Business Phone Number: | 7194426955 |
Business Fax Number: | 7194426947 |
Mailing Address: | 10 Boulder Crescent St Ste 101b, COLORADO SPRINGS |
State: | CO |
Postal Code: | 809033344 |
Phone Number: | 7194426955 |
Fax Number: | 7194426947 |
NPI Enumeration Date: | 12/08/2006 |
NPI Last Update Date: | 12/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 1558 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |