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Waning Moon Llc
Adolescent and Children Mental Health Clinic/Center in O Fallon, Illinois
NPI 1467144675

Waning Moon Llc is an Adolescent and Children Mental Health Clinic/Center based in Belleville, IL and is specialized in Adolescent and Children Mental Health. Waning Moon Llc practices in O Fallon, IL. The NPI Number for Waning Moon Llc is 1467144675 and holds a License No. (Illinois).

The current practice location address for Waning Moon Llc is 502 W State St, O Fallon, IL and can be reached out via phone at 217-891-4931.

Location: 502 W State St, O Fallon, IL, 62226-1526
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1467144675
Provider Name
Waning Moon Llc
Credential
Provider Entity Type
Organization
Address
502 W State St, O Fallon, IL, 62226-1526
Phone Number
217-891-4931
Fax Number
Provider Enumeration Date
05/25/2023
Last Update Date
03/13/2024
institution
Provider Business Practice Location Address Details
Address
502 W State St
City
O Fallon
State
Illinois
Zip
62269-1913
Phone Number
217-891-4931
Fax Number
person
Provider Business Mailing Address Details
Address
502 W State St
City
O Fallon
State
Illinois
Zip
62269-1913
Phone Number
217-891-4931
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
261QM0801X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adult Mental Health
Taxonomy
261QM0850X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
person
Provider's Taxonomy Details 3
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adolescent and Children Mental Health
Taxonomy
261QM0855X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
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