Healthcare Provider Details

I. General information

NPI: 1518131689
Provider Name (Legal Business Name): DIANA LIGHTMOON MA, LPCC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA LYNN ORMOND BA, MA

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALIENTE RD STE 10
SANTA FE NM
87508-9209
US

IV. Provider business mailing address

29 CHAPALA RD
SANTA FE NM
87508-2206
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-4607
  • Fax:
Mailing address:
  • Phone: 505-577-4607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0228
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: