Provider Demographics
NPI:1225374820
Name:LUNA, JASON (MA, LMSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:MA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WILCOX PKWY APT 8
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9799
Mailing Address - Country:US
Mailing Address - Phone:989-418-0777
Mailing Address - Fax:989-885-5999
Practice Address - Street 1:208 WILCOX PKWY APT 8
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9799
Practice Address - Country:US
Practice Address - Phone:989-314-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097990104100000X
MI68020873991041C0700X
MI68011146791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker