Provider Demographics
NPI:1346528361
Name:LUNA, ELIAS J JR (MHC)
Entity Type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:J
Last Name:LUNA
Suffix:JR
Gender:M
Credentials:MHC
Other - Prefix:MR
Other - First Name:ELIAS
Other - Middle Name:J
Other - Last Name:LUNA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:RMHCI
Mailing Address - Street 1:11530 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1302
Mailing Address - Country:US
Mailing Address - Phone:954-744-6096
Mailing Address - Fax:
Practice Address - Street 1:547 NW 9TH AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-8113
Practice Address - Country:US
Practice Address - Phone:954-468-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 8343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health