MEDICARE: MOONVIEW COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1366040040	OTHER	CA	NPPES

General Provider Information

NPI Number	:	1902523772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONVIEW COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION

Provider Business Mailing Address
First Line	:	3560 PINE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3816
Country	:	US
Telephone Number	:	424-242-2690
Fax Number	:

Provider Business Practice Location Address
First Line	:	3560 PINE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3816
Country	:	US
Telephone Number	:	424-242-2690
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATASHA PHILLIPS
Credential	:	LCSW
Telephone Number	:	310-259-1002

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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Directions to “MOONVIEW COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION ” Practice Location

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