Healthcare Provider Details

I. General information

NPI: 1033066634
Provider Name (Legal Business Name): MOON DROP THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE STE A1
ALBUQUERQUE NM
87110-1391
US

IV. Provider business mailing address

3901 GEORGIA ST NE STE A1
ALBUQUERQUE NM
87110-1391
US

V. Phone/Fax

Practice location:
  • Phone: 505-785-7447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN ARAGON
Title or Position: THERAPIST
Credential: LCSW, LSAA
Phone: 505-785-7447