Provider Demographics
NPI:1306191531
Name:MOONEY, ANGELA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:MOONEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 N 3400 E
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5288
Mailing Address - Country:US
Mailing Address - Phone:208-731-6347
Mailing Address - Fax:
Practice Address - Street 1:3619 N 3400 E
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-5288
Practice Address - Country:US
Practice Address - Phone:208-731-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4925101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor