Moonwell Therapy LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MOONWELL THERAPY LLC

Practice address

4721 SW 45TH Ave
Portland, OR 97221-3620

Phone

(512) 900-7602

NPI assigned

Oct 21, 2025

Last updated

Oct 21, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shabd K Khalsa, LPC, CETNPI 1124487962

Title

Owner/LPC

Phone

(512) 689-7173

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shabd Khalsa, LPC

  • Mental Health Counselor
  • Portland, OR
  • NPI 1124487962
  NPD Authorized official

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

{
    "created_epoch": "1761004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1841167103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 SW 45TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972213620",
            "telephone_number": "512-900-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 SW 45TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972213620",
            "telephone_number": "512-900-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONWELL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-21",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "KHALSA",
        "authorized_official_first_name": "SHABD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/LPC",
        "authorized_official_telephone_number": "512-689-7173",
        "authorized_official_credential": "LPC, CET"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Moore Therapy Services, LLC
• Tamu Y Moore-Smith, DNP, CRNP
• Alexander Moore
• Alexandria Rose Moore

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; 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.