Provider Demographics
NPI:1649017104
Name:MOONRISE COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:MOONRISE COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKLYN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-860-0233
Mailing Address - Street 1:296 W 100 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2116
Mailing Address - Country:US
Mailing Address - Phone:801-473-3645
Mailing Address - Fax:
Practice Address - Street 1:296 W 100 S
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2116
Practice Address - Country:US
Practice Address - Phone:801-473-3645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty