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General NPI Number Information
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NPI Number | 1386579183
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Entity Type | Organization
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Legal Business Name | DESERT MOON THERAPY,LLC
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Dates
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Enumeration Date | 06/15/2026
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Last Update Date | 06/15/2026
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Provider Practice Location Address
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Address Line | 110 BERNARD ST
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City | SOCORRO
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State | NM
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Zip | 87801-4585
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Country | US
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Telephone | 505-228-5757
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | SOCORRO
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State | NM
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Zip | 87801-0037
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Country | US
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Telephone | 505-228-5757
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/OWNER
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Name | DAWN MICHELLE SHORES
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Credential | LCSW
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Telephone | 505-228-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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