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General NPI Number Information
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NPI Number | 1669269544
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Entity Type | Organization
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Legal Business Name | INDIGO MOON COUNSELING PLLC
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1711 W JARVIS AVE APT 205
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City | CHICAGO
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State | IL
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Zip | 60626-1674
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Country | US
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Telephone | 914-874-6627
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 W JARVIS AVE APT 205
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City | CHICAGO
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State | IL
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Zip | 60626-1674
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Country | US
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Telephone | 914-874-6627
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH MAURNO
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Credential |
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Telephone | 877-222-6690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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