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BLUE MOON BEHAVIORAL HEALTH, PLLC
NPI 1023841061
Nurse Practitioner - Psychiatric/Mental Health in Rockville, MD

Active since August 23, 2024
199 E MONTGOMERY AVE STE 100, ROCKVILLE, MD 20850(301) 719-2913(301) 867-5278 Get Directions Write a Review

NPPES record last updated: August 23, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Blue Moon Behavioral Health, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLUE MOON BEHAVIORAL HEALTH, PLLC (NPI 1023841061) is a healthcare organization registered as a psychiatric/mental health in Rockville, Maryland and active in the NPI registry since August 2024. The organization lists Shineka Latoya Mack, Owner, as its authorized official.

NPPES Registry Identity

NPI1023841061
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameBLUE MOON BEHAVIORAL HEALTH, PLLC
Location Address199 E MONTGOMERY AVE STE 100Rockville, MD 20850-2361
Mailing Address9302 Wooden RdRaleigh, NC 27617-8214 · (704) 258-6720
Phone(301) 719-2913
Fax(301) 867-5278
Organization SubpartNo
Authorized OfficialShineka Latoya MackOwner · (704) 258-6720
Enumeration DateAugust 23, 2024
NPPES CertifiedAugust 23, 2024
✔ NPI 1023841061 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
199 E MONTGOMERY AVE STE 100, Rockville, MD 20850
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. CHANIKA T. JONES
Case Manager/Care Coordinator
199 E MONTGOMERY AVE STE 100
ROCKVILLE, MD 20850
Montgomery County (301) 979-7186
LONGLIVE HOME CARE MD
Home Health
199 E MONTGOMERY AVE STE 100
ROCKVILLE, MD 20850
Montgomery County (703) 742-7400
CAPITOL HOME CARE
Home Health
199 E MONTGOMERY AVE STE 100
ROCKVILLE, MD 20850
Montgomery County (443) 355-3624
AVENUES ABA MD LLC
Behavior Analyst
199 E MONTGOMERY AVE STE 100
ROCKVILLE, MD 20850
Montgomery County (732) 569-4524
CHRISTIAN SADLER
Behavior Technician
199 E MONTGOMERY AVE STE 100
ROCKVILLE, MD 20850
Montgomery County (443) 601-3823
RITA EGBUCHE
Behavior Analyst
199 E MONTGOMERY AVE STE 100
ROCKVILLE, MD 20850
Montgomery County (240) 350-3507

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blue Moon Behavioral Health, PLLC's NPI number?

The NPI number for Blue Moon Behavioral Health, PLLC is 1023841061. It was assigned to this organization in the NPPES registry on August 23, 2024.

Where is Blue Moon Behavioral Health, PLLC located?

Blue Moon Behavioral Health, PLLC is located at 199 E Montgomery Ave Ste 100, Rockville, MD 20850. The listed phone number is (301) 719-2913.

What is Blue Moon Behavioral Health, PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Blue Moon Behavioral Health, PLLC was last updated on August 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.