=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902523772
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOONVIEW COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2022
-----------------------------------------------------
Last Update Date | 10/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3560 PINE AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90807-3816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-242-2690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3560 PINE AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90807-3816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-242-2690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NATASHA PHILLIPS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 310-259-1002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------