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General NPI Number Information
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NPI Number | 1578387189
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Entity Type | Organization
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Legal Business Name | BIG MOON THERAPY LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2920 21ST ST
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City | HOPKINS
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State | MI
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Zip | 49328-9663
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Country | US
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Telephone | 616-287-0120
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33
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City | HOPKINS
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State | MI
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Zip | 49328-0033
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Country | US
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Telephone | 616-287-0120
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Fax |
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Authorized Official
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Title or Position | OWNER/BCBA
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Name | JENNIFER L ZAPOLNIK
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Credential | BCBA, LBA
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Telephone | 616-287-0120
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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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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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