Beautiful Moon Health & Wellness, LTD.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

BEAUTIFUL MOON HEALTH & WELLNESS, LTD.

Practice address

19590 E Mainstreet Ste 202
Parker, CO 80138-7371

Phone

(720) 544-3801

NPI assigned

Oct 18, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Javonni Henderson, LCSWNPI 1861675548

Title

Owner

Phone

(510) 256-9794

Specialties & licenses 3

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Javonni Henderson

  • Clinical Social Worker
  • Aurora, CO
  • NPI 1861675548
  NPD Authorized official
• Donald A. Ingram, LMT

  • Massage Therapist
  • Parker, CO
  • NPI 1588434260

  Multi-Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1093597619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18121 E HAMPDEN AVE STE C1079",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800133590",
            "telephone_number": "720-544-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19590 E MAINSTREET STE 202",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801387371",
            "telephone_number": "720-544-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUTIFUL MOON HEALTH & WELLNESS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "JAVONNI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-256-9794",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Mechanotherapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Be Well Primary Care LLC
• Be Well Project
• Katherine Elizabeth Beale, LICSW
• Brandon Bealer, DO
• Joel Beary, PT
• Laura Becker, RD
• Courtney Beeler
• Ryan Beerwinkle
• Anna Virginia Behlau, FNP-C, MSN, BSN, RN
• Betsy Beineke

• Clinical Social Worker in Parker, CO
• Providers in Parker, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.