MEDICARE: LUNA LIGHT COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1841083748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA LIGHT COUNSELING

Provider Business Mailing Address
First Line	:	15744 GAULT ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-5149
Country	:	US
Telephone Number	:	213-649-8092
Fax Number	:

Provider Business Practice Location Address
First Line	:	15744 GAULT ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-5149
Country	:	US
Telephone Number	:	213-649-8092
Fax Number	:	213-933-4632

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA T VINTON
Credential	:	LPCC
Telephone Number	:	213-649-0892

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	05/23/2025

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