=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659176725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOON-HART PSYCHOTHERAPY & CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 N MAIN AVE
-----------------------------------------------------
City | GRESHAM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97030-7236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-891-0749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 N MAIN AVE
-----------------------------------------------------
City | GRESHAM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97030-7236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-891-0749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JONI MOON
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 503-891-0749
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------