BLUE MOON THERAPY LLC (NPI# 1205319472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205319472 |
| Entity Type | Organization |
| Organization Name | BLUE MOON THERAPY LLC |
| Practice Address |
400 N Woodlawn Suite 100 Wichita KS 67216-1360 |
| Mailing Address |
1215 E Jump St Wichita KS 67216-1360 |
| Practice Telephone | 3166522580 |
| Mailing Telephone | 3162494447 |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2018-09-12 |
| Authorized Official Name | SHANNON D. GOODWIN (CLINICAL SOCIAL WORKER) |
| Authorized Official Telephone | 3162494447 |
| Authorized Official Credential | LSCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Street Address |
400 N WOODLAWN SUITE 100 |
| City | WICHITA |
| State | KS |
| Zip Code | 67216-1360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972524742 | Theodore A Moeller | Psychologist | 400 N Woodlawn, Suite 202, Wichita, KS 67206 | 2006-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104108422 | Howard W Hackney | Pharmacist | 5555 S. Broadway, Wichita, KS 67216 | 2011-09-13 |
| 1316057185 | Jimmy Lee Shadid | Dentist | 3367 E 47th South, Wichita, KS 67216 | 2006-08-30 |
| 1205877644 | Dillon Companies LLC | Durable Medical Equipment & Medical Supplies | 4747 S Broadway Ave, Wichita, KS 67216 | 2006-06-09 |
| 1790399376 | Miresha Andrews | Massage Therapist | 2851 S Mead St, Wichita, KS 67216-1112 | 2020-09-01 |
| 1629534250 | Mandilyn Coffman | Pharmacist | 2627 S Santa Fe St, Wichita, KS 67216-1132 | 2019-02-19 |
| 1780245522 | Monday T Akintuyi | Registered Nurse | 2828 S Ida St, Wichita, KS 67216-1353 | 2019-06-24 |
| 1740841493 | Compassionate Home Health LLC | Registered Nurse | 2828 S Ida St, Wichita, KS 67216-1353 | 2019-06-24 |
| 1114460813 | Ariel Clementi | Social Worker | 1201 E Jump St, Wichita, KS 67216-1360 | 2016-11-29 |
| 1871106740 | Stevie Jonae Metts | Technician | 1207 E Del Mar St, Wichita, KS 67216-1535 | 2020-08-28 |
| 1376001677 | Holly Lynn Paine | Counselor | 3446 S Ida St, Wichita, KS 67216-1558 | 2019-03-05 |
| Find all providers in zip 67216 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619441680 | Jkc Psych LLC | Clinic/Center | 8100 E 22nd St N Ste 1600, Wichita, KS 67226-2388 | 2019-01-14 |
| 1538642509 | Restoration Family Counseling Services | Clinic/Center | 5120 E Central Ave Ste 1, Wichita, KS 67208-4168 | 2018-09-14 |
| 1811415466 | Awaken Psychology LLC | Clinic/Center | 2552 N Maize Ct Suite 600, Wichita, KS 67205 | 2017-09-05 |
| 1932228533 | Dccca, Inc | Clinic/Center | 1319 W May St, Suite 1319b, Wichita, KS 67213-3505 | 2007-03-28 |
| 1609485804 | Therapeutic Paradigm | Clinic/Center | 7570 W 21st St N Ste 1006c, Wichita, KS 67205-1773 | 2020-07-24 |
| 1659997682 | Nuevo Amanecer LLC | Clinic/Center | 2312 S Meridian Ave Ste 102, Wichita, KS 67213-1912 | 2020-06-25 |
| 1447872718 | Kristi Mcneal LLC | Clinic/Center | 3310 E Douglas Ave, Wichita, KS 67208-3314 | 2020-05-10 |
| 1376163691 | Brent Crane Md LLC | Clinic/Center | 1148 S Hillside St, Wichita, KS 67211-4006 | 2020-04-17 |
| 1134758683 | Midwest Psychiatric Services, LLC | Clinic/Center | 3334 N Grey Meadow Ct, Wichita, KS 67205-8716 | 2020-04-06 |
| 1639714769 | Progressive Growth Counseling & Coaching, LLC | Clinic/Center | 1028 E 1st St N, Wichita, KS 67214-3903 | 2019-11-13 |
| Find all providers in WICHITA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.