Provider Demographics
NPI:1306519780
Name:PHOENIX MOON HEALING, PLLC
Entity type:Organization
Organization Name:PHOENIX MOON HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:806-778-1982
Mailing Address - Street 1:4601 50TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3518
Mailing Address - Country:US
Mailing Address - Phone:806-778-1982
Mailing Address - Fax:
Practice Address - Street 1:4601 50TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3518
Practice Address - Country:US
Practice Address - Phone:806-778-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922367630OtherNPI
1063878015OtherNPI