Healthcare Provider Details

I. General information

NPI: 1245293372
Provider Name (Legal Business Name): LUNA Y SOL COUNSELING CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 E 900 S
SALT LAKE CITY UT
84105-1400
US

IV. Provider business mailing address

2773 FILMORE ST
SALT LAKE CITY UT
84106-3544
US

V. Phone/Fax

Practice location:
  • Phone: 801-949-1993
  • Fax: 801-519-9608
Mailing address:
  • Phone: 801-949-1993
  • Fax: 801-519-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2904883501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DEBRA SYLVESTER
Title or Position: OWNER/DIRECTOR
Credential: L.C.S.W.
Phone: 801-949-1993