MEDICARE: LUNA LEVANA MEDINA-WOLF LMHC, NCC, MCAP

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	101YM0800X	Mental Health Counselor	MH13741	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972976595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUNA LEVANA MEDINA-WOLF LMHC, NCC, MCAP

Provider Business Mailing Address
First Line	:	22553 SWORDFISH DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4614
Country	:	US
Telephone Number	:	561-571-1557
Fax Number	:	561-634-3537

Provider Business Practice Location Address
First Line	:	6919 SW 18TH ST STE 201
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-7010
Country	:	US
Telephone Number	:	561-571-1557
Fax Number	:	561-634-3537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	03/22/2022

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