Provider Demographics
NPI:1245824523
Name:LUNA, BAYLEA JO (QMHP)
Entity type:Individual
Prefix:MRS
First Name:BAYLEA
Middle Name:JO
Last Name:LUNA
Suffix:
Gender:
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 SW RIVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-9501
Mailing Address - Country:US
Mailing Address - Phone:541-571-8140
Mailing Address - Fax:
Practice Address - Street 1:104 KINKADE RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OR
Practice Address - Zip Code:97818
Practice Address - Country:US
Practice Address - Phone:541-481-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X, 247200000X
OR24-QMHPC-001507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other