NPIMap

Organization Active NPI

Wild Moon Integrative Therapies: Cycle-Centered Healing

  • Professional Counselor
  • Wheat Ridge, CO
National Provider Identifier
1114579877
Registry record updated Jul 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
WILD MOON INTEGRATIVE THERAPIES: CYCLE-CENTERED HEALING
Practice address
6101 W 38TH Ave
Wheat Ridge, CO 80033-5146
Phone
(718) 974-6645
NPI assigned
Jul 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2019

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

Authorized official

Name
Ms. Cynthia St.Clair, LPC, R-DMT, RYTNPI 1194224626
Title
Owner/Psychotherapist
Phone
(718) 974-6645

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

6101 W 38TH Ave
Wheat Ridge, CO 80033-5146

Mailing address

6101 W 38TH Ave
Wheat Ridge, CO 80033-5146
Phone (718) 974-6645

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562889600000",
    "number": "1114579877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 W 38TH AVE",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800335146",
            "telephone_number": "718-974-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 W 38TH AVE",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800335146",
            "telephone_number": "718-974-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD MOON INTEGRATIVE THERAPIES: CYCLE-CENTERED HEALING",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-12",
        "last_updated": "2019-07-12",
        "status": "A",
        "authorized_official_last_name": "ST.CLAIR",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "718-974-6645",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC, R-DMT, RYT"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; 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.