Provider Demographics
NPI:1104197789
Name:SILVER MOON LLC
Entity Type:Organization
Organization Name:SILVER MOON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-413-0119
Mailing Address - Street 1:9801 FALL CREEK RD
Mailing Address - Street 2:#124
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4802
Mailing Address - Country:US
Mailing Address - Phone:317-413-0119
Mailing Address - Fax:
Practice Address - Street 1:9801 FALL CREEK RD
Practice Address - Street 2:#124
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4802
Practice Address - Country:US
Practice Address - Phone:317-413-0119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006405A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty