MEDICARE: MRS. DANA M MOODY IMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	F.2200241	OH

General Provider Information

NPI Number	:	1023646890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA M MOODY IMFT

Provider Business Mailing Address
First Line	:	670 MERIDIAN WAY STE 228
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-2305
Country	:	US
Telephone Number	:	614-450-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 MERIDIAN WAY STE 228
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-2305
Country	:	US
Telephone Number	:	614-450-0404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2020
Last Update Date	:	09/26/2025

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