Provider Demographics
NPI:1225847478
Name:FULL MOON BEHAVIORAL PLLC
Entity type:Organization
Organization Name:FULL MOON BEHAVIORAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:IULIA
Authorized Official - Last Name:GHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-870-7412
Mailing Address - Street 1:2139 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:CASTLE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1831
Mailing Address - Country:US
Mailing Address - Phone:210-940-0411
Mailing Address - Fax:830-255-5212
Practice Address - Street 1:2139 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CASTLE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78213-1831
Practice Address - Country:US
Practice Address - Phone:210-940-0411
Practice Address - Fax:830-255-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)