Provider Demographics
NPI:1346954690
Name:LUNA THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:LUNA THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MPS, LPCC, LADC
Authorized Official - Phone:612-702-6012
Mailing Address - Street 1:19912 EXCELSIOR LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8419
Mailing Address - Country:US
Mailing Address - Phone:612-702-6012
Mailing Address - Fax:
Practice Address - Street 1:14041 BURNHAVEN DR STE 125
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4408
Practice Address - Country:US
Practice Address - Phone:612-702-6012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942867783OtherNPPES