Healthcare Provider Details

I. General information

NPI: 1992108211
Provider Name (Legal Business Name): JAMES LUCAS MOONS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES LUCAS MOONS

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 09/20/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CUMBERLAND COUNTY ELEMENTARY HEALTHY KIDS CLINIC 150 GLASGOW RD
BURKESVILLE KY
42717-9695
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax: 270-858-4027
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number176407
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number175407
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: