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1598919995 NPI number — MICHAEL JOSEPH MOONEY MA,LLP,CAC,CCS,CCJP

NPI Number: 1598919995
Health Care Provider/Practitioner: MICHAEL JOSEPH MOONEY MA,LLP,CAC,CCS,CCJP

Information about “1598919995” NPI (MICHAEL JOSEPH MOONEY MA,LLP,CAC,CCS,CCJP) exists in 1598919995 in HTML format HTML  |  1598919995 in plain Text format TXT  |  1598919995 in PDF (Portable Document Format) PDF  |  1598919995 in an XML format XML  formats.

NPI Number : 1598919995 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598919995",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOONEY",
    "FirstName": "MICHAEL",
    "MiddleName": "JOSEPH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA,LLP,CAC,CCS,CCJP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "27700 GRATIOT AVE STE 202",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSEVILLE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48066-4880",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-772-5101",
    "MailingAddressFaxNumber": "586-772-5102",
    "FirstLinePracticeLocationAddress": "27730 GRATIOT AVE STE 202",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSEVILLE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48066-4885",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-772-5101",
    "PracticeLocationAddressFaxNumber": "586-772-5102",
    "EnumerationDate": "11/11/2008",
    "LastUpdateDate": "03/31/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Psychologist",
          "LicenseNumber": "6301012109",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC1900X",
          "TaxonomyName": "Counseling Psychologist",
          "LicenseNumber": "6361001321",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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