NPIMap

Organization Active NPI

Moonlight Mental Health

  • Mental Health Counselor
  • Benton, AR
National Provider Identifier
1780276451
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MOONLIGHT MENTAL HEALTH
Practice address
211 S Main
Benton, AR 72015-4331
Phone
(662) 727-1053
Fax
(501) 214-6867
NPI assigned
Feb 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Authorized official

Name
Lauren Johnson, LPC-SNPI 1851697528
Title
Owner
Phone
(501) 278-1736

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
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

211 S Main
Benton, AR 72015-4331

Mailing address

208 E Richardson Place Dr
Bryant, AR 72022-3246
Phone (501) 278-1736

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1780276451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 E RICHARDSON PLACE DR",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720223246",
            "telephone_number": "501-278-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S MAIN",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154331",
            "telephone_number": "662-727-1053",
            "fax_number": "501-214-6867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLIGHT MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-278-1736",
        "authorized_official_credential": "LPC-S"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.