Provider Demographics
NPI:1831998004
Name:LUNA VISTA BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:LUNA VISTA BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ABEYTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-779-4939
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-0351
Mailing Address - Country:US
Mailing Address - Phone:575-779-4939
Mailing Address - Fax:
Practice Address - Street 1:61B W ROMERO RD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-8747
Practice Address - Country:US
Practice Address - Phone:575-779-4939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty