Provider Demographics
NPI:1144581265
Name:MOONEYHAN, CHRISTOPHER PAUL
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:MOONEYHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 AIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2005
Mailing Address - Country:US
Mailing Address - Phone:707-604-7660
Mailing Address - Fax:
Practice Address - Street 1:3315 AIRWAY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2005
Practice Address - Country:US
Practice Address - Phone:707-604-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)