| Lunar Phase Restorative Health, Llc | |
|
216 W Main St Ste A Richmond KY 40475-1444 | |
| (859) 544-2047 | |
| Not Available |
| Full Name | Lunar Phase Restorative Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 216 W Main St Ste A, Richmond, Kentucky |
| Authorized Official Name and Position | Wesley Sage Belknap-greene (MEMBER) |
| Authorized Official Contact | 8592009858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lunar Phase Restorative Health, Llc 216 W Main St Ste A Richmond KY 40475-1444 Ph: (859) 544-2047 | Lunar Phase Restorative Health, Llc 216 W Main St Ste A Richmond KY 40475-1444 Ph: (859) 544-2047 |
| NPI Number | 1245998467 |
|---|---|
| Provider Enumeration Date | 12/05/2021 |
| Last Update Date | 04/10/2022 |
| Certification Date | 04/10/2022 |
| Medicare PECOS PAC ID | 4486031754 |
|---|---|
| Medicare Enrollment ID | O20220509000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245998467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Wesley Sage Belknap-greene |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861997454 PECOS PAC ID: 5395122667 Enrollment ID: I20220509000301 |
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