DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: NOVA LUNA BEHAVIOR HEALTH SERVICES LLC

MEDICARE: NOVA LUNA BEHAVIOR HEALTH SERVICES LLC
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
1101YM0800XMental Health Counselor
2104100000XSocial Worker
31041C0700XClinical Social Worker
4171M00000XCase Manager/Care Coordinator
52084P0800XPsychiatry Physician
6261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
7101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1417792284
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOVA LUNA BEHAVIOR HEALTH SERVICES LLC
Provider Business Mailing Address
First Line : 1653 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1309
Country : US
Telephone Number : 773-615-5415
Fax Number :
Provider Business Practice Location Address
First Line : 1653 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1309
Country : US
Telephone Number : 773-615-5415
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JESSICA CARRILLO-GUERRERO
Credential :
Telephone Number : 773-615-5415
Provider Enumeration Date : 06/25/2024
Last Update Date : 08/25/2025

Similar Medicare Providers

1811848849 — LUZ ALEXANDRA PEREZ HERRERA
Practice Location Address:
1653 W 35TH ST
CHICAGO, IL
60609-1309
Practice Phone: 708-613-7862
Practice Fax:
1073257770 — JESSICA CARRILLO-GUERRERO LCPC
Practice Location Address:
1653 W 35TH ST
CHICAGO, IL
60609-1309
Practice Phone: 708-613-7862
Practice Fax:
1417687690 — MS. MARIANNE LOPEZ LCPC
Practice Location Address:
1653 W 35TH ST
CHICAGO, IL
60609-1309
Practice Phone: 312-487-1878
Practice Fax:
1801676093 — CASA SOLUNA LLC
Practice Location Address:
1653 W 35TH ST
CHICAGO, IL
60609-1309
Practice Phone: 708-613-7862
Practice Fax:
1871373993 — CARLOS A SAMANIEGO
Practice Location Address:
1653 W 35TH ST
CHICAGO, IL
60609-1309
Practice Phone: 773-426-8054
Practice Fax:
1205642840 — MAYA BEN-SHAHAR
Practice Location Address:
1653 W 35TH ST
CHICAGO, IL
60609-1309
Practice Phone: 708-613-7862
Practice Fax:

Directions to “NOVA LUNA BEHAVIOR HEALTH SERVICES LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.