SUMMER MOON LPC
NPI 1144182650
Counselor in Lagrange, GA

Q: What is Summer Moon's NPI number?

The NPI number for Summer Moon is 1144182650. It was assigned to this individual provider in the NPPES registry on December 2, 2025.

Q: What is Summer Moon's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Q: When was this NPI record last updated?

The NPPES record for Summer Moon was last updated on December 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months 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.

Active since December 02, 2025PECOS EnrolledAccepts Medicare Assignment

401 RIDLEY AVE, LAGRANGE, GA 30240(706) 756-1970 Get Directions Write a Review

NPPES record last updated: December 2, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Summer Moon Lpc NPPES

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

SUMMER MOON LPC (NPI 1144182650) is an individual counselor in Lagrange, Georgia, licensed in Georgia (LPC014910) and active in the NPI registry since December 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1144182650

Entity TypeIndividualFemale

Primary Taxonomy101Y00000X

Provider Legal NameSUMMER MOONCredential: LPC

Location Address401 RIDLEY AVELagrange, GA 30240-2267

Mailing Address121 Crestview RdWest Point, GA 31833-5221 · (706) 585-0204

Phone(706) 756-1970

Sole ProprietorYes

Medical School CMSOtherGraduated 2021

Enumeration DateDecember 2, 2025

NPPES CertifiedDecember 2, 2025

✔ NPI 1144182650 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

License✔ Licensed in GA · LPC014910

Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

401 RIDLEY AVE, Lagrange, GA 30240

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Summer Moon Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3971099961

PECOS Enrollment IDI20251229003271

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 7

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

GRETA ANGSTADT CORK M.S., LPC, NCC

Counselor (Professional)