Provider Demographics
NPI:1326853193
Name:WHOLE MOON HEALING LLC
Entity type:Organization
Organization Name:WHOLE MOON HEALING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:720-445-1258
Mailing Address - Street 1:2519 S SHIELDS ST STE 1K
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1855
Mailing Address - Country:US
Mailing Address - Phone:970-235-1112
Mailing Address - Fax:
Practice Address - Street 1:2519 S SHIELDS ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1855
Practice Address - Country:US
Practice Address - Phone:970-235-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty