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General NPI Number Information
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NPI Number | 1689124117
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Entity Type | Individual
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Provider Name | MR. CHRISTOPHER SCOTT MOON
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Gender | Male
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 790 FULLER AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-336-3909
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Fax | 616-336-8830
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Provider Business Mailing Address
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Address Line | 790 FULLER AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1918
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Country | US
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Telephone | 616-336-3909
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Fax | 616-336-8830
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401223787
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License Number State | MI
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