Provider Demographics
NPI:1598922403
Name:WALLIN & LUNA COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WALLIN & LUNA COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:505-821-5894
Mailing Address - Street 1:PO BOX 21847
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-1847
Mailing Address - Country:US
Mailing Address - Phone:505-821-5894
Mailing Address - Fax:505-404-6452
Practice Address - Street 1:9412 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2878
Practice Address - Country:US
Practice Address - Phone:505-821-5894
Practice Address - Fax:505-404-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0081111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty