Healthcare Provider Details

I. General information

NPI: 1942127329
Provider Name (Legal Business Name): JO-MOON WELLNESS FIRM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76805 CEDAR ST.
GROSSE TETE LA
70740
US

IV. Provider business mailing address

3952 WATERBURY AVE
BATON ROUGE LA
70810-3386
US

V. Phone/Fax

Practice location:
  • Phone: 225-287-3791
  • Fax:
Mailing address:
  • Phone: 225-287-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA ASHLEY GRADNEY
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPC
Phone: 225-287-3791