=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386233070
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KACHINA WENONA MOONEY MA, LPC, ATR-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2021
-----------------------------------------------------
Last Update Date | 09/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3212 MAIN ST FL 1
-----------------------------------------------------
City | MUNHALL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15120-3230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-444-5174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3214
-----------------------------------------------------
City | MUNHALL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15120-6214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-444-5174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 221700000X
-----------------------------------------------------
Taxonomy Name | Art Therapist
-----------------------------------------------------
License Number | 21-002
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | PC015540
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------