Blue Moon Therapy LLC
NPI 1205319472 · Mental Health Clinic/Center (Including Community Mental Health Center) · Wichita, KS
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Blue Moon Therapy LLC is a Mental Health Clinic/Center (Including Community Mental Health Center) organization in Wichita, KS (NPI 1205319472).
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
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2018-09-12
- Last updated
- 2018-09-12
Frequently asked questions
- What is Blue Moon Therapy LLC's NPI number?
- Blue Moon Therapy LLC's National Provider Identifier (NPI) is 1205319472, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Blue Moon Therapy LLC?
- Blue Moon Therapy LLC is classified in the NPPES registry as Mental Health Clinic/Center (Including Community Mental Health Center) (Ambulatory Health Care Facilities).
- Where is Blue Moon Therapy LLC located?
- Blue Moon Therapy LLC's practice location on file with NPPES is 400 N Woodlawn, Wichita, KS 67216-1360.
- What is Blue Moon Therapy LLC's phone number?
- The practice phone number listed in the NPPES registry for Blue Moon Therapy LLC is (316) 652-2580.
- Does Blue Moon Therapy LLC accept Medicare?
- Blue Moon Therapy LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Blue Moon Therapy LLC?
- The authorized official listed on Blue Moon Therapy LLC's NPPES record is Shannon Goodwin, Clinical Social Worker. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Blue Moon Therapy LLC's NPI active?
- Yes — Blue Moon Therapy LLC's NPI (1205319472) is active in the NPPES registry as of the last update on 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.