Provider Demographics
NPI:1215430400
Name:NEW MOON COUNSELING LLC
Entity type:Organization
Organization Name:NEW MOON COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GALINDO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-908-6501
Mailing Address - Street 1:540 CHAMA ST NE STE 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2017
Mailing Address - Country:US
Mailing Address - Phone:505-908-6501
Mailing Address - Fax:
Practice Address - Street 1:540 CHAMA ST NE STE 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2017
Practice Address - Country:US
Practice Address - Phone:505-908-6501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03-356885-00-5OtherCRS