Healthcare Provider Details

I. General information

NPI: 1265996300
Provider Name (Legal Business Name): JULIAN MOON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N 1200 W
OREM UT
84057-2449
US

IV. Provider business mailing address

447 W BEARCAT DR
SALT LAKE CITY UT
84115-2519
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax: 385-225-9327
Mailing address:
  • Phone: 801-355-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0021918
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1671133
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11770839-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: