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General NPI Number Information
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NPI Number | 1225847478
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Entity Type | Organization
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Legal Business Name | FULL MOON BEHAVIORAL PLLC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 2139 NW MILITARY HWY
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City | CASTLE HILLS
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State | TX
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Zip | 78213-1831
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Country | US
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Telephone | 210-940-0411
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Fax | 830-255-5812
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Provider Business Mailing Address
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Address Line | 2139 NW MILITARY HWY
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City | CASTLE HILLS
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State | TX
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Zip | 78213-1831
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Country | US
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Telephone | 210-940-0411
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Fax | 830-255-5212
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Authorized Official
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Title or Position | OWNER
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Name | ELENA IULIA GHERMAN
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Credential | MD
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Telephone | 210-870-7412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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