SOO Y MOON (MA, LMFT) – Marriage & Family Therapist, NPI 1548539042

SOO Y MOON (MA, LMFT) is a healthcare provider. based in Vadnais heights, Minnesota. specializing in MARRIAGE AND FAMILY THERAPIST. They hold the professional credentials MA, LMFT. They hold a License No. 2209 (MN). The NPI Number for SOO Y MOON (MA, LMFT) is 1548539042

Main info

Female
17 Years Of Experience
Accepts Medicare Assignment
Name
SOO Y MOON (MA, LMFT)
NPI
1548539042
Phone
(651) 604-8116
Address
1056 CENTERVILLE CIR
Enumeration Date
29 December 2011
Last Update Date
26 November 2014

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7634008000
Graduation Year
2009 (17 years ago)
PAC ID
4486944196
Group Practice PAC ID
8325338031
Professional Enrollment ID
I20240228000284
Address ID
MN553694528MA11316NXXX400
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience42
Completeness75
Years active:14State licenses:1Digital endpointsOther names

981 MARRIAGE AND FAMILY THERAPIST in MN

Provider Addresses for SOO Y MOON (MA, LMFT)

  • 1056 CENTERVILLE CIR

    VADNAIS HEIGHTS, MN 551276360

    Phone: (651) 604-8116

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-02-28

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240228000284IMarriage And Family TherapistMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55127)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8325338031View full group profile
NameSpecialtyState
Marriage And Family TherapistMN
Clinical PsychologistMN
Mental Health CounselorMN
Mental Health CounselorMN
Mental Health CounselorMN
Marriage And Family TherapistMN
Mental Health CounselorMN
Marriage And Family TherapistMN

Reviews

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Frequently asked questions

How is SOO Y MOON (MA, LMFT) identified in CMS data?
CMS-hosted NPPES data lists SOO Y MOON (MA, LMFT) with NPI 1548539042.
Is SOO Y MOON (MA, LMFT) listed as active for patients and plans?
The listing shows SOO Y MOON (MA, LMFT) as active in the NPI system.
What healthcare role does SOO Y MOON (MA, LMFT) hold?
Scheduling teams often label SOO Y MOON (MA, LMFT) under Marriage & Family Therapist. Clinical services aligned with this taxonomy classification.
Where is SOO Y MOON (MA, LMFT) based?
SOO Y MOON (MA, LMFT) is tied to Vadnais Heights, Minnesota in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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