Provider Demographics
NPI:1295217347
Name:LUNA COUNSELING, LLC
Entity Type:Organization
Organization Name:LUNA COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:PREBYS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, RPT, SP
Authorized Official - Phone:937-717-8643
Mailing Address - Street 1:5959 E CASSTOWN CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CASSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45312-9746
Mailing Address - Country:US
Mailing Address - Phone:937-717-8643
Mailing Address - Fax:
Practice Address - Street 1:30 WARDER ST STE 165
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2500
Practice Address - Country:US
Practice Address - Phone:937-717-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUNA COUNSELING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty