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Organization
BLUE MOON THERAPY LLC
Active
Organization
BLUE MOON THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON D. GOODWIN LSCSW (CLINICAL SOCIAL WORKER)
(316) 249-4447
Entity
Organization
Contact information
Practice address
400 N WOODLAWN, SUITE 100, WICHITA, KS 67216-1360
(316) 652-2580
Mailing address
1215 E JUMP ST, WICHITA, KS 67216-1360
(316) 249-4447
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
09/12/2018
Last updated
09/12/2018
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