MEDICARE: LUNA TIDES COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1356296685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA TIDES COUNSELING

Provider Business Mailing Address
First Line	:	1928 WAYWARD SUN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-5401
Country	:	US
Telephone Number	:	512-843-1213
Fax Number	:

Provider Business Practice Location Address
First Line	:	1928 WAYWARD SUN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-5401
Country	:	US
Telephone Number	:	512-843-1213
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	NADIA VELASQUEZ
Credential	:	LCSW-S
Telephone Number	:	210-268-4052

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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