Provider Demographics
NPI:1902675861
Name:MOEDER, RAQUEL (LCMFT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:MOEDER
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67026-0035
Mailing Address - Country:US
Mailing Address - Phone:620-545-5620
Mailing Address - Fax:
Practice Address - Street 1:651 E PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7408
Practice Address - Country:US
Practice Address - Phone:785-825-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS920106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist