Healthcare Provider Details

I. General information

NPI: 1891622668
Provider Name (Legal Business Name): PHOENIX MOON COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 LAWLER ST
HOLYOKE MA
01040-2929
US

IV. Provider business mailing address

PO BOX 1042
HOLYOKE MA
01041-1042
US

V. Phone/Fax

Practice location:
  • Phone: 860-869-4712
  • Fax:
Mailing address:
  • Phone: 860-869-4712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE STODDARD
Title or Position: MEMBER
Credential: LMFT
Phone: 860-869-4712