| Moonrise Therapy Pllc | |
|
708 Church St Ste 251 Evanston IL 60201-3840 | |
| (773) 517-8105 | |
| Not Available |
| Full Name | Moonrise Therapy Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 708 Church St Ste 251, Evanston, Illinois |
| Authorized Official Name and Position | Darren Diamond (MANAGER) |
| Authorized Official Contact | 5187085405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moonrise Therapy Pllc 708 Church St Ste 251 Evanston IL 60201-3840 Ph: (773) 517-8105 | Moonrise Therapy Pllc 708 Church St Ste 251 Evanston IL 60201-3840 Ph: (773) 517-8105 |
| NPI Number | 1649044058 |
|---|---|
| Provider Enumeration Date | 11/07/2023 |
| Last Update Date | 11/07/2023 |
| Certification Date | 11/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649044058 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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