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General NPI Number Information
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NPI Number | 1033484951
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Entity Type | Organization
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Legal Business Name | MOONEY CONSULTING PLLC
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 7200 FRANCE AVE S SUITE 224
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City | EDINA
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State | MN
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Zip | 55435-4300
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Country | US
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Telephone | 952-831-0422
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Fax | 952-831-0443
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Provider Business Mailing Address
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Address Line | 2505 BENJAMIN ST NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-4003
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Country | US
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Telephone | 612-991-6875
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MARC EDWARD MOONEY
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Credential | PH.D.
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Telephone | 612-991-6875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4773
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License Number State | MN
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