Healthcare Provider Details

I. General information

NPI: 1245824523
Provider Name (Legal Business Name): BAYLEA JO LUNA QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 KINKADE RD
BOARDMAN OR
97818
US

IV. Provider business mailing address

1313 SW RIVERHILL DR
HERMISTON OR
97838-9501
US

V. Phone/Fax

Practice location:
  • Phone: 541-481-2911
  • Fax:
Mailing address:
  • Phone: 541-571-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24-QMHPC-001507
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: