Healthcare Provider Details

I. General information

NPI: 1003084161
Provider Name (Legal Business Name): THOMAS FRANCIS MOONEY EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 62ND SE
SAUGATUCK MI
49453-9701
US

IV. Provider business mailing address

3206 62ND SE
SAUGATUCK MI
49453-9701
US

V. Phone/Fax

Practice location:
  • Phone: 616-666-1510
  • Fax: 866-752-2359
Mailing address:
  • Phone: 616-666-1510
  • Fax: 866-752-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301001704
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: