Provider Demographics
NPI:1942823034
Name:MOONCALF, LLC
Entity Type:Organization
Organization Name:MOONCALF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:515-758-0358
Mailing Address - Street 1:6029 BROADMOOR ST UNIT 234
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66201-2475
Mailing Address - Country:US
Mailing Address - Phone:515-758-0358
Mailing Address - Fax:
Practice Address - Street 1:6029 BROADMOOR ST UNIT 234
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66201-2475
Practice Address - Country:US
Practice Address - Phone:515-758-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty