Provider Demographics
NPI:1841894391
Name:MOONEY, LIZABETH
Entity type:Individual
Prefix:MRS
First Name:LIZABETH
Middle Name:
Last Name:MOONEY
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 1:243 SE 15TH RD
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-9272
Mailing Address - Country:US
Mailing Address - Phone:417-214-3801
Mailing Address - Fax:
Practice Address - Street 1:243 SE 15TH RD
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-9272
Practice Address - Country:US
Practice Address - Phone:417-214-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MH385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO190741720004OtherDRIVERS LICENSE