Provider Demographics
NPI:1033484951
Name:MOONEY CONSULTING PLLC
Entity Type:Organization
Organization Name:MOONEY CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-991-6875
Mailing Address - Street 1:2505 BENJAMIN ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4003
Mailing Address - Country:US
Mailing Address - Phone:612-991-6875
Mailing Address - Fax:
Practice Address - Street 1:7200 FRANCE AVE S
Practice Address - Street 2:SUITE 224
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4300
Practice Address - Country:US
Practice Address - Phone:952-831-0422
Practice Address - Fax:952-831-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN987635000Medicaid
MN680002385Medicare Oscar/Certification