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Organization
MOONWELL THERAPY LLC
Active
Organization
MOONWELL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHABD K KHALSA LPC, CET (OWNER/LPC)
(512) 689-7173
Entity
Organization
Contact information
Practice address
4721 SW 45TH AVE, PORTLAND, OR 97221-3620
(512) 900-7602
Mailing address
4721 SW 45TH AVE, PORTLAND, OR 97221-3620
(512) 900-7602
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/21/2025
Last updated
10/21/2025
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