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General NPI Number Information
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NPI Number | 1215551288
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Entity Type | Organization
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Legal Business Name | MOONSTONE HOLISTIC COUNSELING, PLLC
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 1701 N COLLINS BLVD STE 140
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City | RICHARDSON
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State | TX
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Zip | 75080-3554
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Country | US
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Telephone | 214-789-9025
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Fax |
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Provider Business Mailing Address
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Address Line | 612 LA SALLE DR
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City | RICHARDSON
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State | TX
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Zip | 75081-3510
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Country | US
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Telephone | 214-789-9025
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | LEA M ROMAN
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Credential | MS, LPC, RPT
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Telephone | 214-789-9025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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