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NPI Code Detail

MEDICARE: MOONRISE MIND & WELLNESS LLC

MEDICARE: MOONRISE MIND & WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1831021112
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOONRISE MIND & WELLNESS LLC
Provider Business Mailing Address
First Line : 2222 W GRAND RIVER AVE STE A
Second Line :
City : OKEMOS
State : MI
Zip : 48864-1604
Country : US
Telephone Number : 269-910-3271
Fax Number :
Provider Business Practice Location Address
First Line : 2222 W GRAND RIVER AVE STE A
Second Line :
City : OKEMOS
State : MI
Zip : 48864-1604
Country : US
Telephone Number : 269-910-3271
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DANIELLE L RAMIREZ
Credential : LMSW, LCSW
Telephone Number : 269-910-3271
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “MOONRISE MIND & WELLNESS LLC ” Practice Location

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