Healthcare Provider Details

I. General information

NPI: 1962311431
Provider Name (Legal Business Name): BURIED MOON COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE # 10119
SPOKANE WA
99201-0580
US

IV. Provider business mailing address

522 W RIVERSIDE AVE # 10119
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 360-686-9316
  • Fax: 503-689-8681
Mailing address:
  • Phone: 360-686-9316
  • Fax: 503-689-8681

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: SERENA HAMILTON
Title or Position: OWNER
Credential: LMHC, LPC
Phone: 909-273-1294