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

Waning Moon LLC

Organization Mental Health Clinic/Center (Including Community Mental Health Center) · NPI 1467144675

Waning Moon LLC is a Mental Health Clinic/Center (Including Community Mental Health Center) in O Fallon, Illinois. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

502 W State St
O Fallon, IL 62269-1913
Phone: (217) 891-4931
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Clinic/Center (Including Community Mental Health Center) (primary) Taxonomy 261QM0801X
Adult Mental Health Clinic/Center Taxonomy 261QM0850X
Adolescent and Children Mental Health Clinic/Center Taxonomy 261QM0855X

Record details

NPI number1467144675
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shelby Reece — Owner · (217) 891-4931
NPI enumeratedMay 25, 2023
Last updated in NPPESMay 25, 2023
Certification dateMay 25, 2023
Mailing address201 Blanc Lee Dr, Belleville, IL 62226-1526

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