Provider Demographics
NPI:1215054218
Name:LA LUNA CENTER, LLC
Entity type:Organization
Organization Name:LA LUNA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-470-0010
Mailing Address - Street 1:3002 BLUFF ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2162
Mailing Address - Country:US
Mailing Address - Phone:720-470-0010
Mailing Address - Fax:303-200-7098
Practice Address - Street 1:3002 BLUFF ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2162
Practice Address - Country:US
Practice Address - Phone:720-470-0010
Practice Address - Fax:303-200-7098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty