Provider Demographics
NPI:1194904771
Name:MOON, DOROTHY WINNIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:WINNIE
Last Name:MOON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S JACKSON ST STE 520
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3133
Mailing Address - Country:US
Mailing Address - Phone:720-819-5830
Mailing Address - Fax:
Practice Address - Street 1:300 S JACKSON ST STE 520
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3133
Practice Address - Country:US
Practice Address - Phone:720-819-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0003594103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical