Provider Demographics
NPI:1497366611
Name:HARVEST MOON MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:HARVEST MOON MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORRIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:EHRBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:218-270-4449
Mailing Address - Street 1:1509 E SUPERIOR ST APT 203
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-4402
Mailing Address - Country:US
Mailing Address - Phone:218-251-3686
Mailing Address - Fax:
Practice Address - Street 1:1509 E SUPERIOR ST APT 203
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-4402
Practice Address - Country:US
Practice Address - Phone:218-251-3686
Practice Address - Fax:218-216-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1538618566OtherMENTAL HEALTH