Provider Demographics
NPI:1699809152
Name:MOONEY, FABRICE A (LPC, LBP)
Entity Type:Individual
Prefix:
First Name:FABRICE
Middle Name:A
Last Name:MOONEY
Suffix:
Gender:F
Credentials:LPC, LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 E 9TH ST
Mailing Address - Street 2:UNIT 8
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5772
Mailing Address - Country:US
Mailing Address - Phone:405-285-2080
Mailing Address - Fax:405-285-2565
Practice Address - Street 1:1320 E 9TH ST
Practice Address - Street 2:UNIT 8
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5772
Practice Address - Country:US
Practice Address - Phone:405-285-2080
Practice Address - Fax:405-285-2565
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK1744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health