Crescent Moon Counseling
Organization Active NPI Clinical Social Worker · Angora, MN
NPI 1881328482 · NPPES record last updated Jul 11, 2022
Key facts
- NPI
- 1881328482
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- CRESCENT MOON COUNSELING
- Practice address
- 9708 Highway 22
Angora, MN 55703-8210 - Phone
- (610) 507-0051
- NPI assigned
- Jul 11, 2022
- Organization subpart
- No
Authorized official
- Name
- Lauren M Simensen, LICSW
- Title
- Mental Health Therapist
- Phone
- (610) 507-0051
Practitioners 8
-
Danielle Kuka, LICSW
-
Lauren Marie Simensen, LICSW
-
Amanda Struxness, OTR
-
Raini J Knaeble-Weiss, MSED, LPCC
-
Tatiana Rivera Cruz, LCSW
-
Melissa Fjelstad, LADC, LPCC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221031002493 | MN | Part B Supplier - Clinic/Group Practice | 3476920646 |
Receives reassigned benefits from 7 practitioners Practice locations: Cook, MN; Virginia, MN |
National Provider Directory
Locations
820 9th St N
Virginia, MN 55792
Phone (218) 248-2402
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
9708 Highway 22
Angora, MN 55703-8210
Mailing address
9708 Highway 22
Angora, MN 55703-8210
Phone (610) 507-0051
Other names
- Crescent Moon Counseling
Other providers in Angora, MN
All providers in Angora, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.