Healthcare Provider Details

I. General information

NPI: 1386579183
Provider Name (Legal Business Name): DESERT MOON THERAPY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BERNARD ST
SOCORRO NM
87801-4585
US

IV. Provider business mailing address

PO BOX 37
SOCORRO NM
87801-0037
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-5757
  • Fax:
Mailing address:
  • Phone: 505-228-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAWN MICHELLE SHORES
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: LCSW
Phone: 505-228-5757