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General NPI Number Information
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NPI Number | 1760295604
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Entity Type | Individual
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Provider Name | CHRISTOPHER DAVID MOONEY
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Gender | Male
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 413 W SCOTT ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-2455
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Country | US
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Telephone | 414-902-1500
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Fax | 414-647-8798
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Provider Business Mailing Address
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Address Line | 4930 S 33RD ST
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City | GREENFIELD
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State | WI
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Zip | 53221-2614
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Country | US
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Telephone | 414-732-7932
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7451-226
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License Number State | WI
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