Healthcare Provider Details

I. General information

NPI: 1295433068
Provider Name (Legal Business Name): LUNASA COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3393 IRIS AVE STE 104
BOULDER CO
80301-1956
US

IV. Provider business mailing address

8919 FIELD ST UNIT 123
WESTMINSTER CO
80021-4694
US

V. Phone/Fax

Practice location:
  • Phone: 303-736-9566
  • Fax:
Mailing address:
  • Phone: 303-736-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KRISTEN O'KELLY
Title or Position: CO-FOUNDER/ THERAPIST
Credential: CAS, LPCC
Phone: 303-736-9566