Provider Demographics
NPI:1447862560
Name:NEW MOON COUNSELING AND WELLNESS, LLC
Entity type:Organization
Organization Name:NEW MOON COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-A, NCC
Authorized Official - Phone:828-507-9488
Mailing Address - Street 1:2350 HEATHER WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2611
Mailing Address - Country:US
Mailing Address - Phone:828-507-9488
Mailing Address - Fax:
Practice Address - Street 1:713 MILLPOND RD STE 8
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1570
Practice Address - Country:US
Practice Address - Phone:859-539-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100677810Medicaid