Provider Demographics
NPI:1295986503
Name:LUNA-KEATON, MELISSA MARIA
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARIA
Last Name:LUNA-KEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 E MOUNT MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-9721
Mailing Address - Country:US
Mailing Address - Phone:810-515-4278
Mailing Address - Fax:
Practice Address - Street 1:5135 E MOUNT MORRIS RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-9721
Practice Address - Country:US
Practice Address - Phone:810-515-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS250010894253J00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities