Provider Demographics
NPI:1447436001
Name:MOODY, JOSEPH GAROLD (LPC, NCC, RSAP-P)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:GAROLD
Last Name:MOODY
Suffix:
Gender:M
Credentials:LPC, NCC, RSAP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOSPITAL ROAD.
Mailing Address - Street 2:PINEY RIDGE CENTER
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583
Mailing Address - Country:US
Mailing Address - Phone:573-774-5353
Mailing Address - Fax:573-774-2907
Practice Address - Street 1:1000 HOSPITAL ROAD.
Practice Address - Street 2:PINEY RIDGE CENTER
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-774-5353
Practice Address - Fax:573-774-2907
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006010874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health