| Waning Moon Llc | |
|
502 W State St O Fallon IL 62269-1913 | |
| (217) 891-4931 | |
| Not Available |
| Full Name | Waning Moon Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 502 W State St, O Fallon, Illinois |
| Authorized Official Name and Position | Shelby Reece (OWNER) |
| Authorized Official Contact | 2178914931 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Waning Moon Llc 201 Blanc Lee Dr Belleville IL 62226-1526 Ph: (217) 891-4931 | Waning Moon Llc 502 W State St O Fallon IL 62269-1913 Ph: (217) 891-4931 |
| NPI Number | 1467144675 |
|---|---|
| Provider Enumeration Date | 05/25/2023 |
| Last Update Date | 05/25/2023 |
| Certification Date | 05/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467144675 | NPI | - | NPPES |
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