Provider Demographics
NPI:1083481238
Name:LUNA ARMENTA, JOSE (EDS NCSP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:LUNA ARMENTA
Suffix:
Gender:M
Credentials:EDS NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4118
Mailing Address - Country:US
Mailing Address - Phone:479-750-8880
Mailing Address - Fax:
Practice Address - Street 1:409 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4118
Practice Address - Country:US
Practice Address - Phone:479-750-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10053422103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool