Blue Moon of Colorado LLC
NPI #1629593967 in Plainfield, Illinois
Provider Information
- NPI Number
- 1629593967
- Entity Type
- Organization
- Organization Name
- Blue Moon of Colorado LLC
- Primary Specialty
- Social Worker - Clinical
- Enumeration Date
- Aug 8, 2017
- Last Updated
- Sep 20, 2019
Practice Location
- Address
- 10204 BODE ST STE B
- City
- Plainfield
- State
- Illinois
- ZIP Code
- 60585-9813
- Phone
- (855) 241-7160
Authorized Official
- Name
- MELANIE DONOHUE
- Title
- AUTHORIZED OFFICIAL
- Phone
- (702) 403-0438
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychologist |
| Social Worker - Clinical — Clinical |
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