Healthcare Provider Details

I. General information

NPI: 1679138861
Provider Name (Legal Business Name): SUSAN LUNA, LPCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 B CANDELARIA NE
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

PO BOX 11364
ALBUQUERQUE NM
87192-0364
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-9893
  • Fax:
Mailing address:
  • Phone: 505-819-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SUSAN LUNA
Title or Position: OWNER
Credential: LPCC
Phone: 505-819-9893