Provider Demographics
NPI:1699409623
Name:RISING MOON THERAPY, LLC
Entity Type:Organization
Organization Name:RISING MOON THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PROF. COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CURELO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR-BC
Authorized Official - Phone:541-435-0304
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0048
Mailing Address - Country:US
Mailing Address - Phone:541-435-0304
Mailing Address - Fax:541-394-4142
Practice Address - Street 1:375 PARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2242
Practice Address - Country:US
Practice Address - Phone:541-435-0304
Practice Address - Fax:541-394-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)