Provider Demographics
NPI:1669100715
Name:MOON, MAYA ZEN
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:ZEN
Last Name:MOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 E 61ST ST APT 7G
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1396
Mailing Address - Country:US
Mailing Address - Phone:918-998-6771
Mailing Address - Fax:
Practice Address - Street 1:994 E 61ST ST APT 3E
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1312
Practice Address - Country:US
Practice Address - Phone:918-998-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker