1558056580 NPI number — CRESCENT MOON COUNSELING, LLC

Table of content: DR. CHRISTOPHER MATTHEW PRICE MD (NPI 1740623263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558056580 NPI number — CRESCENT MOON COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESCENT MOON COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558056580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMERY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54001-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-952-9072
Provider Business Mailing Address Fax Number:
888-715-2506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 E ENTERPRISE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54913-7889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-952-9072
Provider Business Practice Location Address Fax Number:
888-715-2506
Provider Enumeration Date:
04/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
RAMM
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
MENTAL HEALTH THERAPIST
Authorized Official Telephone Number:
715-952-9072

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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