Provider Demographics
NPI:1821506932
Name:LUNARIA BIRTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:LUNARIA BIRTH & WELLNESS, LLC
Other - Org Name:BLOOMING TREE MATERNITY AND WELLNESS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:512-585-4389
Mailing Address - Street 1:815 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3055
Mailing Address - Country:US
Mailing Address - Phone:512-585-4389
Mailing Address - Fax:512-793-9243
Practice Address - Street 1:815 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3055
Practice Address - Country:US
Practice Address - Phone:512-585-4389
Practice Address - Fax:512-793-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X, 261QB0400X, 261QC1500X
TXMT119285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Multi-Specialty