MEDICARE: MICHAEL MOONEY, INC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1932102308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL MOONEY, INC

Provider Business Mailing Address
First Line	:	27730 GRATIOT AVE
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-4838
Country	:	US
Telephone Number	:	586-772-5101
Fax Number	:	586-772-5102

Provider Business Practice Location Address
First Line	:	27700 GRATIOT AVE STE 202
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-4880
Country	:	US
Telephone Number	:	586-350-6800
Fax Number	:	586-772-5102

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	MR. MICHAEL JOSEPH MOONEY
Credential	:	MA, LLP, CAC-II, CCS
Telephone Number	:	586-772-5101

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/06/2023

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Directions to “MICHAEL MOONEY, INC ” Practice Location

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