Provider Demographics
NPI:1598919995
Name:MOONEY, MICHAEL JOSEPH (MA,LLP,CAC,CCS,CCJP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MOONEY
Suffix:
Gender:M
Credentials:MA,LLP,CAC,CCS,CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27700 GRATIOT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4880
Mailing Address - Country:US
Mailing Address - Phone:586-772-5101
Mailing Address - Fax:586-772-5102
Practice Address - Street 1:27730 GRATIOT AVE STE 202
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4885
Practice Address - Country:US
Practice Address - Phone:586-772-5101
Practice Address - Fax:586-772-5102
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012109103TA0400X
MI6361001321103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)