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General NPI Number Information
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NPI Number | 1942127329
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Entity Type | Organization
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Legal Business Name | JO-MOON WELLNESS FIRM, LLC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 76805 CEDAR ST.
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City | GROSSE TETE
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State | LA
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Zip | 70740
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Country | US
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Telephone | 225-287-3791
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Fax |
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Provider Business Mailing Address
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Address Line | 3952 WATERBURY AVE
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City | BATON ROUGE
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State | LA
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Zip | 70810-3386
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Country | US
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Telephone | 225-287-3791
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MRS. AMANDA ASHLEY GRADNEY
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Credential | LPC
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Telephone | 225-287-3791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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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Taxonomy #3
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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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