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New Moon Mental Health LLC

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Company Details

Name: New Moon Mental Health LLC
Jurisdiction: Idaho
Legal type: Foreign Name Registration
Status: Inactive-Expired
Date of registration: 05 Oct 2023 (2 years ago)
Expiration date: 31 Dec 2024
Date dissolved: 11 Jan 2025
Entity Number: 5433077
Place of Formation: WYOMING
File Number: 901701
ZIP code: 83404
County: Bonneville County
Mailing Address: STE 111B 1970 E 17TH ST IDAHO FALLS, ID 83404-8046

National Provider Identifier

NPI Number:
1508647983
Certification Date:
2023-10-11

Authorized Person:

Name:
DENISE BARNES
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2087422695

Filing

Filing Name Filing Number Filing date
Initial Filing 0005433077 2023-10-05

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Date of last update: 21 May 2025

Sources: Idaho Secretary of State