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General NPI Number Information
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NPI Number | 1629147889
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Entity Type | Individual
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Provider Name | KAREN MELISSA MOON LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 26 E MEADOW ST STE 9
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5357
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Country | US
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Telephone | 479-368-0036
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Fax |
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Provider Business Mailing Address
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Address Line | 2733 N VILLA BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3333
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Country | US
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Telephone | 479-841-6536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5498-C
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License Number State | AR
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