Provider Demographics
NPI:1427455955
Name:MOONEY, BENJAMIN (MPH)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MOONEY
Suffix:
Gender:M
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 STATE HIGHWAY 161
Mailing Address - Street 2:#325-2
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2432
Mailing Address - Country:US
Mailing Address - Phone:214-283-9852
Mailing Address - Fax:
Practice Address - Street 1:6913 STATE HIGHWAY 161
Practice Address - Street 2:#325-2
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2432
Practice Address - Country:US
Practice Address - Phone:214-283-9852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist