Provider Demographics
NPI:1972370914
Name:MOODY, MARNI (LMHC)
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:
Last Name:MOODY
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:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:MANSON
Mailing Address - State:IA
Mailing Address - Zip Code:50563-0812
Mailing Address - Country:US
Mailing Address - Phone:515-570-8176
Mailing Address - Fax:
Practice Address - Street 1:1416 8TH ST
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:IA
Practice Address - Zip Code:50563-5136
Practice Address - Country:US
Practice Address - Phone:515-570-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty