Provider Demographics
NPI:1457094575
Name:LA LUNE INTEGRATIVE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:LA LUNE INTEGRATIVE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:206-531-7844
Mailing Address - Street 1:522 W RIVERSIDE AVE STE 4117
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:206-531-7844
Mailing Address - Fax:503-386-3252
Practice Address - Street 1:522 W RIVERSIDE AVE STE 4117
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0580
Practice Address - Country:US
Practice Address - Phone:206-531-7844
Practice Address - Fax:503-386-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61085917OtherSTATE LICENSE