Healthcare Provider Details

I. General information

NPI: 1396469078
Provider Name (Legal Business Name): ARISE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24624 INTERSTATE 45 N STE 200
SPRING TX
77386-4084
US

IV. Provider business mailing address

30711 SHADY TRACE DR
SPRING TX
77386-3878
US

V. Phone/Fax

Practice location:
  • Phone: 832-910-9817
  • Fax:
Mailing address:
  • Phone: 254-383-8499
  • 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
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN LOSHUN MOON
Title or Position: LPC-A
Credential: MA
Phone: 254-383-8499