Provider Demographics
NPI:1013899012
Name:LUNA, CHRYSTAL
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:LUNA
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 1:2430 PAUL AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33973-6131
Mailing Address - Country:US
Mailing Address - Phone:239-944-0757
Mailing Address - Fax:
Practice Address - Street 1:708 GOODLETTE-FRANK RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5644
Practice Address - Country:US
Practice Address - Phone:239-351-0675
Practice Address - Fax:239-310-2045
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-453387106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician