Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Moonrise Therapy PLLC

Organization Psychologist · NPI 1649044058

Moonrise Therapy PLLC is a Psychologist in Evanston, Illinois. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

708 Church St Ste 251
Evanston, IL 60201-3840
Phone: (773) 517-8105
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X

Record details

NPI number1649044058
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Darren Diamond — Manager · (518) 708-5405
NPI enumeratedNovember 7, 2023
Last updated in NPPESNovember 7, 2023
Certification dateNovember 7, 2023
Mailing address708 Church St Ste 251, Evanston, IL 60201-3840

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