Healthcare Provider Details

I. General information

NPI: 1336785906
Provider Name (Legal Business Name): TREY ALBRECHT LUNA LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HEMPHILL ST STE A
FORT WORTH TX
76104-3105
US

IV. Provider business mailing address

700 HEMPHILL ST STE A
FORT WORTH TX
76104-3105
US

V. Phone/Fax

Practice location:
  • Phone: 817-334-0111
  • Fax: 817-334-0249
Mailing address:
  • Phone: 817-334-0111
  • Fax: 817-334-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11272
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: