Provider Demographics
NPI:1629134531
Name:MOONEY, JAMES PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:MOONEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 13TH ST NE STE 502
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2203
Mailing Address - Country:US
Mailing Address - Phone:503-581-2351
Mailing Address - Fax:503-581-0125
Practice Address - Street 1:325 13TH ST NE STE 502
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2203
Practice Address - Country:US
Practice Address - Phone:503-581-2351
Practice Address - Fax:503-581-0125
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR1088103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR840547000OtherREGENCE BLUE CROSS
OR204144521OtherFEDERAL TAX ID
ORR0000TCPDJOtherMEDICARE ID-PIN
OR0203219OtherDEPARTMENT OF LABOR & IND
WA0203219OtherDEPARTMENT OF LABOR & IND
ORR0000TCPDJMedicare PIN