=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619262714
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN ELIZABETH MOONEY MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2011
-----------------------------------------------------
Last Update Date | 07/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 E AVENUE R 9-203
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93550-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-309-0111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 EAST AVE R 9-205
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-309-0111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LMFT 44724
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------