=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497544241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE MOON THERAPY & CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2025
-----------------------------------------------------
Last Update Date | 01/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23121 RUTT RD
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19963-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-313-0040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19213 CAVENDISH WAY
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-4968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-313-0040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | TERESA JEANNE LEAR DOYLE
-----------------------------------------------------
Credential | PHD, LMFT
-----------------------------------------------------
Telephone | 703-313-0040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------