MEDICARE: LUNA NUEVA MENTAL HEALTH, 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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1477125557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA NUEVA MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	2723 CINNAMON TEAL
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-1256
Country	:	US
Telephone Number	:	512-925-4037
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 SUTTLES AVE
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-5015
Country	:	US
Telephone Number	:	830-402-4186
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA DEHOYOS
Credential	:
Telephone Number	:	505-226-5525

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	03/13/2024

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