Provider Demographics
NPI:1396408142
Name:LUNA CONSULTING AND THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:LUNA CONSULTING AND THERAPEUTIC SERVICES, LLC
Other - Org Name:THE IVY MENTAL HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-696-9971
Mailing Address - Street 1:1700 SW 57TH AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2163
Mailing Address - Country:US
Mailing Address - Phone:561-696-9971
Mailing Address - Fax:
Practice Address - Street 1:1700 SW 57TH AVE STE 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2163
Practice Address - Country:US
Practice Address - Phone:561-696-9971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty