MEDICARE: MOON WELLNESS GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1811563604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOON WELLNESS GROUP, PLLC

Provider Business Mailing Address
First Line	:	2395 OAK VALLEY DR STE 100
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9118
Country	:	US
Telephone Number	:	734-707-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	2395 OAK VALLEY DR STE 100
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9118
Country	:	US
Telephone Number	:	734-681-0830
Fax Number	:

Authorized Official
Title or Position	:	PHD
Name	:	MIEA MOON
Credential	:	PHD
Telephone Number	:	734-681-0830

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	04/27/2026

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