Healthcare Provider Details

I. General information

NPI: 1407491749
Provider Name (Legal Business Name): MS. AURIZTELLE Y LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 S HOWELL AVE
MILWAUKEE WI
53207-6157
US

IV. Provider business mailing address

800 WISCONSIN AVE
RACINE WI
53403-1526
US

V. Phone/Fax

Practice location:
  • Phone: 844-545-1735
  • Fax: 262-821-6180
Mailing address:
  • Phone: 262-637-8888
  • Fax: 262-637-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4504-226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8637-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: