Provider Demographics
NPI:1902184807
Name:LUNA, ALICIA MICHELLE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MICHELLE
Last Name:LUNA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MICHELLE
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:8321 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2606
Mailing Address - Country:US
Mailing Address - Phone:916-733-2172
Mailing Address - Fax:
Practice Address - Street 1:8321 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2606
Practice Address - Country:US
Practice Address - Phone:916-733-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist