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General NPI Number Information
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NPI Number | 1104197789
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Entity Type | Organization
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Legal Business Name | SILVER MOON LLC
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 9801 FALL CREEK RD #124
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4802
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Country | US
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Telephone | 317-413-0119
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Fax |
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Provider Business Mailing Address
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Address Line | 9801 FALL CREEK RD #124
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4802
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Country | US
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Telephone | 317-413-0119
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH FARR
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Credential | LCSW
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Telephone | 317-413-0119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34006405A
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License Number State | IN
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