Provider Demographics
NPI:1528516572
Name:NOVA LUNA EDUCATION AND CONSULTATION CENTER, LLC
Entity type:Organization
Organization Name:NOVA LUNA EDUCATION AND CONSULTATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR CLINICIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADOKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:614-347-9930
Mailing Address - Street 1:9109 TAHOMA ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-6025
Mailing Address - Country:US
Mailing Address - Phone:614-347-9930
Mailing Address - Fax:
Practice Address - Street 1:9109 TAHOMA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6025
Practice Address - Country:US
Practice Address - Phone:614-347-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH82103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty