Provider Demographics
NPI:1760811723
Name:NEW MOON SERVICES
Entity Type:Organization
Organization Name:NEW MOON SERVICES
Other - Org Name:SEASIDE COUNSELING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-452-9527
Mailing Address - Street 1:13936 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-4543
Mailing Address - Country:US
Mailing Address - Phone:727-452-9527
Mailing Address - Fax:813-489-8924
Practice Address - Street 1:3825 HENDERSON BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5037
Practice Address - Country:US
Practice Address - Phone:727-452-9527
Practice Address - Fax:813-489-8924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-09
Last Update Date:2013-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11441251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health