Healthcare Provider Details

I. General information

NPI: 1659176725
Provider Name (Legal Business Name): MOON-HART PSYCHOTHERAPY & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 04/01/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N MAIN AVE
GRESHAM OR
97030-7236
US

IV. Provider business mailing address

502 N MAIN AVE
GRESHAM OR
97030-7236
US

V. Phone/Fax

Practice location:
  • Phone: 503-891-0749
  • Fax:
Mailing address:
  • Phone: 503-891-0749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONI MOON
Title or Position: OWNER
Credential: PSY.D.
Phone: 503-891-0749