Provider Demographics
NPI:1922767490
Name:MOONFLOWER THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:MOONFLOWER THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STILWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:567-801-6279
Mailing Address - Street 1:277 MARGARET PL
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1724
Mailing Address - Country:US
Mailing Address - Phone:330-419-0518
Mailing Address - Fax:
Practice Address - Street 1:218 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1438
Practice Address - Country:US
Practice Address - Phone:567-801-6279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty