Provider Demographics
NPI:1366051096
Name:MOONEY-MOSS, AMANDA DIANE (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DIANE
Last Name:MOONEY-MOSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-3434
Mailing Address - Country:US
Mailing Address - Phone:409-420-2517
Mailing Address - Fax:
Practice Address - Street 1:2039 S WHEELER ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5603
Practice Address - Country:US
Practice Address - Phone:281-766-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional