Provider Demographics
NPI:1689761553
Name:MOONEYHAM, JONNA J (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JONNA
Middle Name:J
Last Name:MOONEYHAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2711
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65779-9809
Mailing Address - Country:US
Mailing Address - Phone:573-680-2535
Mailing Address - Fax:888-301-6832
Practice Address - Street 1:RR 2 BOX 2711
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:MO
Practice Address - Zip Code:65779-9809
Practice Address - Country:US
Practice Address - Phone:573-680-2535
Practice Address - Fax:888-301-6832
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005030090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497594721Medicaid
MO497594705Medicaid