Healthcare Provider Details

I. General information

NPI: 1356938591
Provider Name (Legal Business Name): LUNA MENTAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 FEDERAL BLVD # 203
DENVER CO
80211-3741
US

IV. Provider business mailing address

2580 BLUE HERON CIR W
LAFAYETTE CO
80026-9141
US

V. Phone/Fax

Practice location:
  • Phone: 720-277-6125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BROOKE VANEK
Title or Position: OWNER/ THERAPIST
Credential: MA, LPC
Phone: 720-277-6125