Provider Demographics
NPI:1558963157
Name:MOONBEAM COUNSELING LLC
Entity Type:Organization
Organization Name:MOONBEAM COUNSELING LLC
Other - Org Name:MOONBEAM COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:FLOYD-HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:303-444-3323
Mailing Address - Street 1:150 MAIN ST STE 26
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3131
Mailing Address - Country:US
Mailing Address - Phone:303-444-3323
Mailing Address - Fax:413-779-3395
Practice Address - Street 1:150 MAIN ST STE 26
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3131
Practice Address - Country:US
Practice Address - Phone:303-444-3323
Practice Address - Fax:413-779-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty