Organization
MOONRISE THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN DIAMOND (MANAGER)
(518) 708-5405
Entity
Organization
Contact information
Practice address
708 CHURCH ST STE 251, EVANSTON, IL 60201-3840
(773) 517-8105
Mailing address
708 CHURCH ST STE 251, EVANSTON, IL 60201-3840
(773) 517-8105
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
11/07/2023
Last updated
11/07/2023
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