Provider Demographics
NPI:1427721547
Name:COLEUS, LUNIE
Entity type:Individual
Prefix:
First Name:LUNIE
Middle Name:
Last Name:COLEUS
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 1:5450 CLARCONA KEY BLVD APT 1116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-3287
Mailing Address - Country:US
Mailing Address - Phone:407-459-6301
Mailing Address - Fax:
Practice Address - Street 1:5450 CLARCONA KEY BLVD APT 1116
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-3287
Practice Address - Country:US
Practice Address - Phone:407-459-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health