Provider Demographics
NPI:1497756480
Name:MOON, HSIAO-WEN EUNICE (LPC)
Entity type:Individual
Prefix:MRS
First Name:HSIAO-WEN
Middle Name:EUNICE
Last Name:MOON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:HSIAO-WEN
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:107 REMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4169
Mailing Address - Country:US
Mailing Address - Phone:325-672-8883
Mailing Address - Fax:325-672-8883
Practice Address - Street 1:4911 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6171
Practice Address - Country:US
Practice Address - Phone:405-751-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC07800101YM0800X
TX004863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096063501Medicaid