Provider Demographics
NPI:1649491101
Name:LUNA, CELINA E (MA)
Entity type:Individual
Prefix:MS
First Name:CELINA
Middle Name:E
Last Name:LUNA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CELINA
Other - Middle Name:E
Other - Last Name:LA FORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:13801 E BENSON HWY
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-9074
Mailing Address - Country:US
Mailing Address - Phone:520-879-2926
Mailing Address - Fax:
Practice Address - Street 1:12775 E MARY ANN CLEVELAND WAY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-8600
Practice Address - Country:US
Practice Address - Phone:520-879-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool