Provider Demographics
NPI:1497544241
Name:BLUE MOON THERAPY & CONSULTING, LLC
Entity type:Organization
Organization Name:BLUE MOON THERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:LEAR DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:703-313-0040
Mailing Address - Street 1:19213 CAVENDISH WAY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4968
Mailing Address - Country:US
Mailing Address - Phone:703-313-0040
Mailing Address - Fax:
Practice Address - Street 1:23121 RUTT RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-4806
Practice Address - Country:US
Practice Address - Phone:703-313-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty