| Crescent Moon Awakening | |
|
300 James Cir Russellville AR 72801-5811 | |
| (314) 246-0086 | |
| Not Available |
| Full Name | Crescent Moon Awakening |
|---|---|
| Speciality | Counselor - Professional |
| Location | 300 James Cir, Russellville, Arkansas |
| Authorized Official Name and Position | Hazel Moon (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 3142460086 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crescent Moon Awakening 300 James Cir Russellville AR 72801-5811 Ph: (314) 246-0086 | Crescent Moon Awakening 300 James Cir Russellville AR 72801-5811 Ph: (314) 246-0086 |
| NPI Number | 1154160364 |
|---|---|
| Provider Enumeration Date | 05/20/2024 |
| Last Update Date | 07/27/2024 |
| Certification Date | 07/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154160364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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