Healthcare Provider Details

I. General information

NPI: 1164351177
Provider Name (Legal Business Name): ASHLEY DAWN MOON LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 MILLERSTOWN RD
UPTON KY
42784-9432
US

IV. Provider business mailing address

3055 MILLERSTOWN RD
UPTON KY
42784-9432
US

V. Phone/Fax

Practice location:
  • Phone: 270-307-7841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number308608
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: