Provider Demographics
NPI:1386233070
Name:MOONEY, KACHINA WENONA (MA, LPC, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:KACHINA
Middle Name:WENONA
Last Name:MOONEY
Suffix:
Gender:F
Credentials:MA, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3214
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-6214
Mailing Address - Country:US
Mailing Address - Phone:412-444-5174
Mailing Address - Fax:
Practice Address - Street 1:3212 MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-3230
Practice Address - Country:US
Practice Address - Phone:412-444-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
21-002221700000X
PAPC015540101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty