Provider Demographics
NPI:1942768791
Name:MOON, MICHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GRANDVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2077
Mailing Address - Country:US
Mailing Address - Phone:814-676-5614
Mailing Address - Fax:814-677-5760
Practice Address - Street 1:815 GRANDVIEW ROAD
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2077
Practice Address - Country:US
Practice Address - Phone:814-676-5614
Practice Address - Fax:814-677-5760
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional