# RADIANT MOON, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Radiant Mind Wellness, Kathryn Wingard Creative Counseling
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811651938
- **Authorized official:** MRS. KATHRYN WINGARD LCMHC, ATR-BC (OWNER/CLINICAL DIRECTOR)
- **Authorized official phone:** (385) 346-0031

## Contact information

- **Practice address:** 940 E SOUTH UNION AVE, MIDVALE, UT 84047-2302
- **Practice address phone:** (385) 346-0031
- **Practice address fax:** (385) 446-0973
- **Mailing address:** 5622 S WALDEN GLEN DR, SALT LAKE CITY, UT 84123-7925
- **Mailing address phone:** (385) 346-0031
- **Mailing address fax:** (385) 446-0973

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 221700000X | Art Therapist | — | NULL | — |
| 221700000X | Art Therapist | — | — | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/25/2021
- **Last updated:** 12/19/2023