Healthcare Provider Details

I. General information

NPI: 1265759336
Provider Name (Legal Business Name): REBECCA LYNN MOONEYHAN M.HDL., CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S MILLS AVE
ORLANDO FL
32806-4151
US

IV. Provider business mailing address

2000 S MILLS AVE
ORLANDO FL
32806-4151
US

V. Phone/Fax

Practice location:
  • Phone: 407-893-7237
  • Fax: 407-893-7221
Mailing address:
  • Phone: 407-893-7237
  • Fax: 407-893-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number139
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0974
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7055
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: