Healthcare Provider Details

I. General information

NPI: 1831998004
Provider Name (Legal Business Name): LUNA VISTA BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 SAINT FRANCIS LN UNIT 3
TAOS NM
87571-8240
US

IV. Provider business mailing address

PO BOX 351
RANCHOS DE TAOS NM
87557-0351
US

V. Phone/Fax

Practice location:
  • Phone: 575-779-2828
  • Fax:
Mailing address:
  • Phone: 575-779-2828
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE V ABEYTA
Title or Position: DIRECTOR/OWNER
Credential: MBA
Phone: 575-779-2828