OrganizationActive
Blue Moon Therapy LLC
NPI 1205319472 · Mental Health Clinic/Center (Including Community Mental Health Center) · Wichita, KS
Provider details
- NPI number
- 1205319472
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Shannon Goodwin, Clinical Social Worker(316) 249-4447
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
400 N Woodlawn
Suite 100
Wichita, KS 67216-1360
Phone: (316) 652-2580
Approximate (ZIP-level) locationGet directions
Mailing address
1215 E Jump St
Wichita, KS 67216-1360
Registry dates
- Enumerated
- 2018-09-12
- Last updated
- 2018-09-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.