Moontower Wellness, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

N6094 Issued in TX

Legal business name

MOONTOWER WELLNESS, LLC

Practice address

11705 Airport Way Ste 205
Broomfield, CO 80021-2710

Phone

(512) 522-7708

NPI assigned

Apr 16, 2012

Organization subpart

No

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

Authorized official

Name

Dr. William Coleman Weatherby, DONPI 1306007604

Title

Member/Manager

Phone

(512) 522-7708

Specialties & licenses 1

Addresses

Other names 1

• Moontower Mental Wellness, PLLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

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

• William Coleman Weatherby, D.O.

  • Psychiatry Physician
  • Broomfield, CO
  • NPI 1306007604

  TX

  Medicare reassignment NPD Authorized official
• Connie Young Benfield, PHD ABPP

  • Clinical Psychologist
  • Abilene, TX
  • NPI 1548363716
  NPD (past)

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1295092252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11705 AIRPORT WAY STE 205",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800212710",
            "telephone_number": "512-522-7708",
            "fax_number": "512-233-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11705 AIRPORT WAY STE 205",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800212710",
            "telephone_number": "512-522-7708"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1154 Lydia St Ste 110",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787022619",
            "country_code": "US",
            "telephone_number": "512-522-7708",
            "fax_number": "512-233-0824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOONTOWER WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-16",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "WEATHERBY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "COLEMAN",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "512-522-7708",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "N6094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moontower Mental Wellness, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• James D. Montgomery, CMT
• Jordan Montz
• Brett Monzel, LSW
• Karissa Moriah Moody, LMFT
• Claire Sophie Mooney
• Harmony Elise Moore
• Taylor Moore
• Rhianna Morgan
• Ryann Tanner Morgan, MA, LPC
• Sally Morgan, LPC

• Psychiatry Physician in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Psychiatry Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.