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General NPI Number Information
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NPI Number | 1316804891
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Entity Type | Organization
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Legal Business Name | CRESCENT MOON AWAKENING
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 307 JAMES CIR
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5829
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Country | US
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Telephone | 479-880-3682
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Fax |
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Provider Business Mailing Address
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Address Line | 307 JAMES CIR
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5829
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Country | US
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Telephone | 479-880-3682
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HAZEL MOON
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Credential | MS LPC
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Telephone | 479-880-3682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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