Provider Demographics
NPI:1588448658
Name:MOON WELLNESS LLC
Entity type:Organization
Organization Name:MOON WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON RAESS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:660-341-1071
Mailing Address - Street 1:834 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4454
Mailing Address - Country:US
Mailing Address - Phone:660-341-1071
Mailing Address - Fax:
Practice Address - Street 1:488 N MAIN ST STE 2N
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5126
Practice Address - Country:US
Practice Address - Phone:630-296-7073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty