Healthcare Provider Details

I. General information

NPI: 1902574437
Provider Name (Legal Business Name): LUNA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11414 W CENTER RD STE 211
OMAHA NE
68144-4487
US

IV. Provider business mailing address

11414 W CENTER RD STE 211
OMAHA NE
68144-4487
US

V. Phone/Fax

Practice location:
  • Phone: 402-812-8203
  • Fax:
Mailing address:
  • Phone: 402-812-8203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARINA ANN LUNA
Title or Position: MENTAL HEALTH THERAPIST
Credential: LISW
Phone: 402-812-8203