MEDICARE: MRS. HSIAO-WEN EUNICE MOON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC07800	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497756480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HSIAO-WEN EUNICE MOON LPC

Provider Business Mailing Address
First Line	:	107 REMINGTON PL
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-4169
Country	:	US
Telephone Number	:	325-672-8883
Fax Number	:	325-672-8883

Provider Business Practice Location Address
First Line	:	4911 N PORTLAND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6171
Country	:	US
Telephone Number	:	405-751-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/24/2025

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