Provider Demographics
NPI:1215257019
Name:MOON, KATIE (LMHC)
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 11TH ST NW
Mailing Address - Street 2:ABBE CENTER COMMUNITY MENTAL HEALTH
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405
Mailing Address - Country:US
Mailing Address - Phone:319-398-3562
Mailing Address - Fax:319-398-3501
Practice Address - Street 1:520 11TH ST NW
Practice Address - Street 2:ABBE CENTER COMMUNITY MENTAL HEALTH
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405
Practice Address - Country:US
Practice Address - Phone:319-398-3562
Practice Address - Fax:319-398-3501
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health