Healthcare Provider Details

I. General information

NPI: 1497337489
Provider Name (Legal Business Name): SANTIAGO LUIS LUNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 N COUNTRY HOMES BLVD STE 201
SPOKANE WA
99208-4376
US

IV. Provider business mailing address

11844 BANDERA RD # 201
HELOTES TX
78023-4132
US

V. Phone/Fax

Practice location:
  • Phone: 509-558-7559
  • Fax:
Mailing address:
  • Phone: 210-319-9807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61647914
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-134369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: