Healthcare Provider Details

I. General information

NPI: 1215877683
Provider Name (Legal Business Name): MOONRISE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 N HOLLAND SYLVANIA RD APT 3113
TOLEDO OH
43623-3549
US

IV. Provider business mailing address

4430 N HOLLAND SYLVANIA RD APT 3113
TOLEDO OH
43623-3549
US

V. Phone/Fax

Practice location:
  • Phone: 419-704-1000
  • 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: KAITLYN BACHMANN
Title or Position: CLINICAL THERAPIST AND OWNER
Credential: MSW, LISW-S
Phone: 419-704-1000