| Moonlight Mental Health | |
|
211 S Main Benton AR 72015-4331 | |
| (662) 727-1053 | |
| (501) 214-6867 |
| Full Name | Moonlight Mental Health |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 211 S Main, Benton, Arkansas |
| Authorized Official Name and Position | Lauren Johnson (OWNER) |
| Authorized Official Contact | 5012781736 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moonlight Mental Health 208 E Richardson Place Dr Bryant AR 72022-3246 Ph: (501) 278-1736 | Moonlight Mental Health 211 S Main Benton AR 72015-4331 Ph: (662) 727-1053 |
| NPI Number | 1780276451 |
|---|---|
| Provider Enumeration Date | 02/04/2021 |
| Last Update Date | 02/04/2021 |
| Certification Date | 02/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780276451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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