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General NPI Number Information
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NPI Number | 1831998004
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Entity Type | Organization
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Legal Business Name | LUNA VISTA BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 61B W ROMERO RD
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-8747
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Country | US
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Telephone | 575-779-4939
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 351
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-0351
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Country | US
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Telephone | 575-779-2828
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Fax |
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | NICOLE V ABEYTA
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Credential | MBA
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Telephone | 575-779-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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